Structure and function of anticoagulation clinics in the United States: an AC forum membership survey
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Many anticoagulation clinics have adapted their services to provide care for patients taking direct oral anticoagulants (DOAC) in addition to traditional warfarin management. Anticoagulation clinic scope of service and operations in this transitional environment have not been well described in the literature. A survey was conducted of United States-based Anticoagulation Forum members to inquire about anticoagulation clinic structure, function, and services provided. Survey responses are reported using summary or non-parametric statistics, when appropriate. Unique clinic survey responses were received from 159 anticoagulation clinics. Clinic structure and staffing are highly variable, with approximately half of clinics (52%) providing DOAC-focused care in addition to traditional warfarin-focused care. Of those clinics managing DOAC patients, this accounts for only 10% of their clinic volume. These clinics commonly have a DOAC follow up protocol (75%). Clinics assign a median of 190.5 (interquartile range 50–300) patients per staff full-time-equivalent, with more patients assigned in phone-based care clinics than in face-to-face based care clinics. Most clinics (68.5%) report receiving reimbursement, which occur either through a combination of patient and insurance provider billing (78.2%), insurance reimbursement only (19.5%) or patient reimbursement only (2.3%). There is wide heterogeneity in anticoagulation clinic structure, function, and services provided. Half of all survey-responding anticoagulation clinics provide care for DOAC-treated patients. Understanding how changes in healthcare policy and reimbursement have impacted these clinics remains to be explored.
This research was funded by Pfizer and Bristol-Myers Squibb. GDB, XG, EKR, CG, EP, and JBF are employees of the University of Michigan which received financial support from Pfizer and Bristol-Myers Squibb in connection with the research presented in this manuscript.
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Conflict of interest
GDB has received consulting fees from Pfizer, Bristol-Myers Squibb, Janssen, and Portola along with research support from Pfizer, Bristol-Myers Squibb, and the National Heart, Lung, and Blood Institute. EKR has received consulting fees from the American College of Physicians. JBF has received consulting fees from Pfizer, Bristol-Myers Squibb, and Janssen along with research funding from Pfizer and Bristol-Myers Squibb.
This project was reviewed and deemed exempt from regulation by the University of Michigan institutional review board (HUM00126169).
Consent was implied when survey respondents elected to complete the survey.
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