Anticoagulation
===============

* Patrick J. Potter

*   © 2004 Canadian Medical Association or its licensors

I very much like the concept of optimizing patient care by choosing the best methods of care on the basis of research findings. Having been a general practictioner for a number of years, as well as acting in the capacity of a specialist, I recognize the differences in expectations placed upon these 2 types of medical practice. 

Thus, it would be helpful if Jo-Anne Wilson and associates1 could comment on what they perceive as the differences in anticoagulation services between the anticoagulation clinics and the family physicians' offices in their study. It would also be helpful to know how the model for anticoagulation monitoring used by family physicians differed from that used in the anticoagulation clinics. For example, who called the patient to convey INR results, and how often were patients seen during the anticoagulation period? In terms of optimizing care, do the authors feel that anticoagulation might be better managed if the physician were able to focus on just that aspect of care, rather than having to address multiple problems during the same visit (as is usually the case for family physicians)? With regard to patient education about anticoagulation, should information be provided by the physician or by other staff (e.g., nurses)? Finally, did the authors review the differences in cost between the 2 types of service?

All of these details might help in optimizing the model of anticoagulation care.

**Patrick J. Potter** Department of Physical Medicine and Rehabilitation University of Western Ontario London, Ont.

## Footnotes

*   *Competing interests:* None declared.

## Reference

1.  1. Wilson SJA, Wells PS, Kovacs MJ, Lewis GM, Martin J, Burton E, et al. Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial. CMAJ 2003;169(4): 293-8.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjkvNC8yOTMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTcwLzQvNDQ3LjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)