Introduction
Increasingly, assessments of patient satisfaction with the service provision are used alongside clinical and economic evaluations to inform service developments within the NHS. Where there are no marked improvements in clinical outcomes or significant cost savings, the patient perspective plays an important role in contributing evidence towards the implementation of new services. Previous evaluations of the provision of anticoagulation services in Barts and the London NHS Trust identified that mobility-impaired (transport) patients would benefit from service development¹. A randomised controlled crossover study was designed to evaluate the effects of setting up a domiciliary anticoagulation service from November 2003. Two home services were tested: one involved a trained pharmacist; the other involved a general phlebotomist. Measures included patient satisfaction.

Aim 
To compare the satisfaction of transport patients with hospital and domiciliary anticoagulation services.

Method 
The original questionnaire comprised the validated 8-item Client Satisfaction Questionnaire (CSQ-8)². In addition, specific items were developed to identify further specific factors that contribute to patient satisfaction with anticoagulation services. The questionnaire was initially administered to both ambulant and non-ambulant patients at the Trust (non-intervention group). Subsequently patients were recruited into the domiciliary trial; they were randomised to receive the pharmacist-led domiciliary service and the domiciliary service involving the phlebotomist. At the crossover stage of the domiciliary trial, questionnaires were posted to the 84 trial participants. Data were analysed using SPSS version 12.

Results
Data is presented for the three groups. 71 mobility-impaired patients in the non-intervention group completed the CSQ-8 of these, 36 responded to the specific items. 71 domiciliary trial participants (n=34 phlebotomist group, n=37 pharmacist group) returned CSQ-8 and specific items at the crossover stage of the trial. There were no significant differences between the 3 groups� age and gender. Overall, the Cronbach�s alpha for the CSQ-8 was 0.79. Comparing the CSQ scores of the groups (Kruskal Wallis test), there was a significant difference between the groups (Chi-square =13.7, df=2 p=0.001). The graph shows that there was no difference in satisfaction with the home services, however there was a significant difference in satisfaction between the intervention domiciliary groups compared to the non-intervention group.

Discussion
The data suggest that provision of a domiciliary service significantly improved the overall satisfaction of mobility-impaired patients with anticoagulation services. The satisfaction of mobility-impaired patients� at the end of the trial is currently being evaluated.

Graph 1: Satisfaction with anticoagulation services

1. Akinwunmi F*, Engov� D*, Duggan C� , Madhani M^#, Bates I*, MacCallum P^# Development of a role of an outreach pharmacist in anticoagulation services. Pharmacy world and science 2004 (In press).
2. Larsen DL, Attkinsson CC, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Evaluation Program Planning 1979; 2: 197-207.