Does Anticoagulant Control Change Following Referral Back to the Primary Care Physician?
Does Anticoagulant Control Change Following Referral Back to the Primary Care Physician?
Warfarin is a medication typically referred to as a blood thinner and is used to prevent the
 formation of blood clots, and hence prevent life-threatening events such as strokes and clots
 on the lungs (known as pulmonary emboli). This therapy is only safe and effective if the
 degree of blood thinning is kept within a narrow window - if the blood is "too thick" clots
 may form but if the blood is "too thin" the risk of bleeding increases. Complicating the
 control of warfarin is that different people require different amounts of it to have an
 appropriate degree of blood thinning, and once this amount is determined for a patient, it
 may be changed by factors that are encountered on a daily basis (i.e., diet, acute and
 chronic diseases, alcohol, medications, etc.). As such, regular monitoring is necessary to
 confer the benefits of this medication. Our Anticoagulation Management Service (AMS) has
 demonstrated really good control of blood thinning therapy by working with patients to inform
 them of the rationale for this medicine, the factors having the ability to impact its
 control, and encouraging the patient to be involved in their care (via provision of tools to
 document test results, one-on-one education and access to our program at any time with
 questions, etc.) Currently, our AMS has to limit the volume of patients seen due to resource
 limitations. As such, it is imperative that we investigate alternate strategies to manage
 these patients. Paramount, however, is that any long-term strategy must not confer inferior
 control of warfarin. The purpose of this study is to determine if the impact of AMS Care is
 sustained following the transfer of anticoagulation management to the family doctor.
 Operationally, the results of this study will guide future management of patients. If control
 of warfarin therapy declines with family doctor management, alternate strategies, such as
 patient self-management, will need to be investigated in a larger scale trial.
Inclusion Criteria:

 -  current patient of the Anticoagulation Management Service

 -  anticipated need for long term anticoagulation

 -  have a regular primary care physician

 Exclusion Criteria:

 -  previous failure of warfarin therapy (a bleed or clot despite therapeutic
 anticoagulation

 -  have a planned procedure (surgery) mandating discontinuation of warfarin

 -  are taking warfarin for a mechanical valve indication