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

* Garey Mazowita

*   © 2004 Canadian Medical Association or its licensors

The article about anticoagulant management by Jo-Anne Wilson and associates1 raises some larger questions about how we deploy system resources and utilize health care personnel. It is perhaps not surprising that dedicated anticoagulation clinics did marginally better than family physicians in providing anticoagulation services. The same may also be true of clinical outcomes at other specialized clinics.

However, we must also acknowledge just how well family physicians have done in addressing these clinical matters in an accessible, convenient, comfortable and inexpensive fashion. The value of family physicians (and other skilled generalists) clearly rests in the evidenced-based provision of a broad range of services, often during the same visit, with specialty support as needed. The public values such service and repeatedly identifies the family physician as the health care provider of choice. 

We need to be clear about the possible paths before us: multiple specialty facilities, adequately resourced and therefore probably expensive, with a consequent reduction in the range of care provided by family physicians, or a recommitment to primary care and generalist physicians so that they can carry out services for which they have been perfectly well trained. Hopefully, such care will be delivered in an interdisciplinary fashion, with appropriate, clearly defined specialty involvement that has been conceived with attention to the role and resources of primary care.

Anticoagulation is but one example of activities that might be “decanted” away from family physicians, so we had better define our preferred model of care, and soon. We need to decide where and how the excellent, cost- effective and accessible care that we all want can best be delivered and how best to support its providers. The consequences of not doing so are concerning to me as a family physician and must be equally or more concerning to those who fund and use the system.

**Garey Mazowita** Medical Director, Primary Care Winnipeg Regional Health Authority Winnipeg, Man.

## 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/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjkvNC8yOTMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTcwLzQvNDUwLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)