Monitoring anticoagulant control in general practice: comparison of management in areas with and without access to hospital anticoagulant.

BACKGROUND Hospital anticoagulant clinics are available only in some areas. There is little information on the contribution of general practitioners to oral anticoagulant monitoring, and whether their management varies with access to hospital clinics. AIM A study was undertaken to compare general practice management of anticoagulant therapy in two health boards with contrasting access to hospital clinics. METHOD A postal questionnaire was sent to the senior partners in all 198 practices in Lothian and Fife, Scotland. RESULTS Lack of access to hospital clinics in Lothian health board resulted in more practices reporting taking sole responsibility for anticoagulant control than in Fife where there was access (P < 0.001). However, there was no significant difference in management policies. Overall, 93% of practices used a protocol for thrombotest target ranges, but 75% had no policy on review frequency and only 2% assessed complication or failure rates. Reduced access to hospital clinics was associated with a decreased likelihood of favouring hospital involvement. Sole responsibility for anticoagulant management was undertaken by 56% of general practices, although only 21% of doctors viewed this as ideal. Most general practitioners felt that they should monitor patients on anticoagulant therapy but should refer to hospital those with problematic control. CONCLUSION Access to hospital clinics affected the degree of involvement of general practitioners in oral anticoagulant monitoring, but did not considerably alter their management practice.