Excellence in locality based community outreach anticoagulation clinic for Hounslow
by St David's Practice Anticoagulation Outreach Team
The team formulated its community service to fit with the borough of Hounslow’s priority of bringing care closer to home. They work with an often elderly patient population to help them manage their condition safely and effectively in the community, so ensuring access to the service for this vulnerable group of patients was key.
Delivery was changed from a telephone-based service to one that worked face-to-face on first-name terms with patients.
The team provide leaflets, tailored dietary and medical advice, and highlight other patients’ success stories.
The model they developed is cost effective and enables them to deal with a substantial workload showing they can stabilise patients’ anticoagulation management in a tailored way.
"One entry outshone all the other entries. We liked that this initiative developed a team who could be trusted with patients away from the GP. The focus was on tailored and holistic care for patients in the community not normally catered for – those with dementia or co-morbidity. The evaluation was thorough and well-presented and it was extremely patient focussed."