August 10, 2001

Care expanded for patients with bleeding and clotting disorders

Featured Image

Dr. Harry R. Jacobson, vice chancellor for Health Affairs, discussed the Meharry-Vanderbilt Alliance this week at the 2001 Annual Convention and Scientific Assembly of the National Medical Association. (photo by Dana Johnson)

Care expanded for patients with bleeding and clotting disorders

As part of a national trend, the Vanderbilt Hemostasis-Thrombosis Clinic (VHTC) is expanding its program to provide comprehensive care to patients who suffer from clotting disorders and bleeding disorders in addition to hemophilia.

For years, medical professionals who treated and researched bleeding disorders devoted the majority of their time to the study and treatment of hemophilia, an inherited bleeding disorder that primarily affects men. As a result of this focus, some women with bleeding disorders and people with clotting disorders have historically not received the kind of outreach, treatment, and education that is available to patients with hemophilia, said Dr. Robert L. Janco, associate professor of Pediatrics Hematology-Oncology.

VHTC, led by Janco and Dr. Anne Neff, assistant professor of Pathology and Medicine, co-director of the clinic and the blood bank director, hopes to change that with the expansion of its services.

“We have just been approved through hospital budget to significantly expand our program … to provide enhanced services for all patients in our referral area,” Janco said.

Currently, VHTC offers team-based comprehensive care on a regular basis to approximately 160 people with hemophilia A, hemophilia B, von Willebrands disorder, and other less common bleeding disorders.

As a result of its expansion, VHTC will be able to offer the same type of care to people with clotting disorders, such as thrombophilia. This will require the hiring of several additional non-physician team members. According to Janco, VHTC’s goal is to have the hiring process finished and expanded services started on Oct. 1, 2001.

Although VHTC has been seeing patients with thrombophilia since February 2000, the clinic could not offer comprehensive care to large numbers of patients with clotting disorders until now because of staffing concerns.

The team-based multidisciplinary model for care was first adopted at VHTC approximately 15 years ago so that patients’ overall health care needs and treatment may be monitored and designed by professionals who specialize in bleeding and clotting disorders, Mary G. Hudson, RN, senior nurse coordinator, said.

In addition to physicians, patients in VHTC are also regularly seen by Mavis Harrop, licensed social worker, Vicki Hannig, genetics counselor, and Karen Gurucharri, physical therapist. Other team members include Hudson, pharmacist Johnna Oleis, and staff nurse Regine Marlowe.

Each team member assesses a patient’s condition and needs in their area, and all members consult with one another to decide a treatment plan.

“My focus with the hemostasis-thrombosis team is to assess the psychosocial needs, provide counseling, education, and generally help our client cope with having a chronic illness,” said Harrop.

The clinic also coordinates the treatment of each patient’s related health care needs. The VHTC team interacts with many other disciplines, such as pharmacy, surgery, and dentistry, to organize a patient’s care.

“Bleeding or clotting patients require special expertise to accommodate their hemostatic needs around invasive procedures,” Neff said. “Each patient is different in his pharmacologic regimen that optimizes outcome. We are here to provide that expertise.”

The high level of care provided by VHTC has resulted in cost savings for the clinic’s patients and their families by reducing the number of emergency room visits and episodes of hospitalization.

“Because of our comprehensive package, we provide excellent care for our patients,” Hudson said. “Therefore, other providers in the medical center may not be aware of the clinic due to the fact that our preventive care may eliminate the need for patients to be seen in other departments.”

While other clinics offer similar models for comprehensive care, according to Janco, Vanderbilt’s HTC is unique because it is multi-disciplinary, interdepartmental, and prevention-oriented. The primary goal of VHTC is to keep its patients healthy.

“If we can keep our patients out of the hospital, they can go to work, school, and be productive members of society,” Harrop said.

The success of VHTC’s program can be further seen in the appointments of three of the team’s members to key advisory roles for the National Hemophilia Foundation (NHF). Janco, Hudson, and Harrop are all currently serving on the national committees in their respective areas.

“It is unique for three people from the same hemophilia clinic to be appointed to national advisory boards,” Janco said. “[VHTC] is perceived as being a key player in terms of standards of care.”

The National Hemophilia Foundation is an advocacy group that raises money for research, monitors the nation’s blood supply, and works to raise awareness about hemophilia.