This story originally appeared in IHI's 2008 Annual Progress Report.
Louis Lyons likes to work — at 76 he still sells real estate — and he likes to play, with a special fondness for fishing. He knows he’s lucky to be doing both these days, after having endured more than his share of health challenges in the past three years.
He’s had major heart surgery twice, spending 30 days in intensive care the second time, hovering somewhere between life and death. Now, to help control his arrhythmia, he is on a precise regimen of powerful anticoagulant medications.
“Patients are understandably scared to take blood thinners,” says William Wightkin, PharmD, RPh, Director of Pharmacy at OSF St. James–John W. Albrecht Medical Center in Pontiac, Illinois. “Too much, and you could bleed. Too little, and you could have a clot.” Anticoagulants are tricky to dose and to monitor, because they can take from one to three days to take effect. In addition, it’s often not clear what other factors push a patient’s anticoagulant levels out of therapeutic range.
That’s why for patients like Lyons and others with atrial fibrillation, pulmonary thrombosis, deep vein thrombosis, and other conditions requiring anticoagulant therapy, OSF St. James’ anticoagulation clinic is so important. Dedicated to helping patients manage these medications, the clinic contrasts with the more typical care model in which patients are managed by their primary care provider.
“Research shows that the dedicated care model does a better job at keeping people in the therapeutic range, with fewer recurring clotting episodes, fewer bleeding episodes, and better control,” says Wightkin. He cites studies showing that primary physician management effectively manages between 40 percent and 50 percent of patients, while clinics control upwards of 60 percent. “That may not sound great, but with this therapy, it is,” says Wightkin.
Lyons visits the clinic three to four times a month, gets an instant blood test and consults with the nurse and pharmacist if necessary to adjust his dose. The nurse travels around the region to OSF’s other sites, holding regular half-day clinics. “We don’t have to train nurses at every site in anticoagulant management,” says Wightkin. “It’s a very efficient model.” The hospital serves as a 5 Million Lives Campaign Mentor Hospital
for safe use of high-hazard medications