Patient and Physician Satisfaction with a Telephone-based Anticoagulation Service


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Address correspondence to Dr. Waterman: Division of General Medical Sciences, Washington University School of Medicine, BJC Mailstop 90–31–661, 660 S. Euclid, St. Louis, MO 63110 (e-mail:


OBJECTIVES: To compare the satisfaction and knowledge of patients who have their warfarin managed by their physician or by a multidisciplinary, telephone-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 physicians 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 normalized ratio (INR) monitoring, perceived safety of warfarin, overall satisfaction with their warfarin management, and knowledge of what a high INR meant. We asked physicians at ACS-available health centers how many minutes they saved per INR by referring patients to the ACS, their satisfaction with the 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 taking warfarin (mean 5.7 vs 5.2, P = .04). Physicians reported that using the ACS saved, on average, four minutes of their time and 13 minutes of their staff's time, per INR. All physicians recommended use of the ACS to a colleague and were highly satisfied with the ACS.

CONCLUSIONS: A telephone-based ACS can be endorsed by primary-care physicians and improve patients' satisfaction with and knowledge about their antithrombotic therapy.