Optimizing clinical management in a health care unit: an innovative experience

The increase of anticoagulation drug therapy indications translates into a rise of patients, which need primary healthcare monitoring and control. Managers have to adjust health professionals' timetables -of doctors and nurses to adapt them to the increasing demand. Collaborative nurse prescription is being tested in Andalusia. Implementing this development would allow our clinical management unit to optimize the amount of time dedicated to monitor patients taking anticoagulation drug therapy. When nurses monitor patients and determine anticoagulant drug therapy dosage, the amount of time that general practitioners dedicate to this group of patients is reduced, increasing their time for other duties such as: augmenting the amount of available medical appointments, providing better attention during the appointments, and increasing their availability to respond to emergencies within the unit, among others. We ran a pilot study designing a clinical trial to establish the viability of the project. We monitored 146 patients randomly assigned patients, both to the control and experimental group during four and a half months. We evaluated the expenditure of test strips, the cost of service time, INR values, the time of therapeutic range and consultations. Results showed a statistical significant difference: when nurses dose and monitor patients, patients have more time of therapeutic range, the number of visits declines, and the expenditure of test strips is reduced (AU)