Monitoring therapy with anticoagulants in The Netherlands.

In The Netherlands, the monitoring of outpatients on oral anticoagulant treatment is conducted, in 95% of the cases, by specialized centers, the so-called "trombosediensten." These centers are recognized by the Ministry of Public Health, Welfare and Sports and must satisfy certain standards and requirements. The centers are united in the "Federatie van Nederlandse Trombosediensten" that provides support in quality assessment and is a board for the negotiations with the government and other authorities. An attempt is made to describe the operation, quality assessment, and the results obtained by these centers by using data from the "Federatie" and one of the centers, in particular. The Dutch system provides a relatively cheap and safe method for treatment with oral anticoagulants, based upon centers where all necessary knowledge is concentrated. The system depends highly upon good communication between referring physician, staff, physicians of the centers, and the patients.