mind the gap: results of a multispecialty survey on coordination of care for peri-procedural anticoagulation

To understand how physicians from various specialties perceive coordination of care when managing peri-procedural anticoagulation. cross-sectional survey of cardiologists, gastroenterologists, and primary care physicians (pcps) in an integrated health system (n = 251). the survey began with a vignette of a patient with atrial fibrillation co-managed by his pcp, cardiologist, and an anticoagulation clinic who must hold warfarin for a colonoscopy. respondents’ experiences and opinions around responsibilities and institutional support for managing peri-procedural anticoagulation were elicited using multiple choice questions. we examined differences in responses across specialties using chi square analysis. the response rate was 51% (n = 127). 52% were pcps, 28% cardiologists, and 21% gastroenterologists. nearly half (47.2%) of respondents believed that the cardiologist should be primarily responsible for managing peri-procedural anticoagulation, while fewer identified the pcp (25.2%), anticoagulation clinic (21.3%), or gastroenterologist (6.3%; p = 0.09). respondents across specialties had significantly different approaches to deciding how to manage the clinical case presented (p < 0.001). most cardiologists (60.0%) would decide whether to offer bridging without consulting with other providers or clinical resources, while most pcps would decide after consulting clinical resources (57.6%). gastroenterologists would most often (46.2%) defer the decision to another provider. a majority of all three specialties agreed that their institution could do more to help manage peri-procedural anticoagulation, and there was broad support (88.1%) for anticoagulation clinics’ managing all aspects of peri-procedural anticoagulation. providers across specialties agree that their institution could do more to help manage peri-procedural anticoagulation, and overwhelmingly support anticoagulation clinics’ taking responsibility.