Patient and physician satisfaction with a telephone-based anticoagulation service

OBJECTIVES: To compare the satisfaction and knowledge of patients who have their warfarin managed by their physician or by a multidisciplinary, teleph one-based anticoagulation service (ACS) and to assess referring physicians' satisfaction with the ACS. DESIGN AND PARTICIPANTS: We surveyed 300 patients taking warfarin (mean age 73 years): 150 at health centers randomized to have access to an ACS, and 150 at control health centers without ACS access. We also surveyed 17 physi cians who refer patients to the ACS. SETTING: Eight outpatient health centers in Missouri and Southern Illinois. MEASUREMENTS: We asked patients about the timeliness of international norma lized ratio (INR) monitoring, perceived safety of warfarin, overall satisfa ction with their warfarin management, and knowledge of what a high INR mean t. We asked physicians at ACS-available health centers how many minutes the y saved per INR by referring patients to the ACS, their satisfaction with t he ACS, and their willingness to recommend the ACS to a colleague. MAIN RESULTS: As compared with patients at control health centers, patients at ACS-available health centers were more satisfied with the timeliness of getting blood test results (mean 4.31 vs 4.03, P = .02), were more likely to know what a safe INR value was (45% vs 15%, P = .001), and felt safer ta king warfarin (mean 5.7 vs 5.2, P = .04). Physicians reported that using th e ACS saved, on average, four minutes of their time and 13 minutes of their staff's time, per INR. An physicians recommended use of the ACS to a colle ague and were highly satisfied with the ACS. CONCLUSIONS: A telephone-based ACS can be endorsed by primary-care physicia ns and Improve patients' satisfaction with and knowledge about their antith rombotic therapy.