Legal and professional implications of shared care: a case study in oral anticoagulation stroke prevention therapy

Jacqueline A Nicholls, Henry WW Potts, Bridget Coleman, David L Patterson

Policy initiatives and technological advances enable the use of integrated shared care models of healthcare delivery whereby the focus of care is moved from the hospital to the community, and also of models where patients take increasing responsibility for monitoring and treatment. Such shifts may or may be perceived to change professional roles and responsibilities with implications to the delivery of a professionally and legally acceptable standard of care. We focus on oral anticoagulation and stroke prevention therapy to examine some possible professional and legal implications of the increasing use of shared care. This paper sought to explore how changes in service delivery influence the discharge of professional responsibilities to patients receiving oral anti-coagulation therapy in the context of clinicians' legal and professional duties. We used a case study of the implementation of a distributed care anti-coagulation service. Qualitative data were collected using complementary methods: participant observation, reflective journaling and legal analysis. Concerns identified by this study included a fear of litigation among both hospital and community-based professionals, a reluctance to embrace an extended role, uncertainty among professionals about the extent of their responsibilities and associated difficulties around adequate exchanges of information. These concerns reflected uncertainty among professionals about the legal and professional scope of the duty of care they owed patients. The findings from this study emphasise the importance of clear role definition, communication and inter-agency cooperation for the successful implementation of a shared care service in which threats to professional and legal standards of care are minimised.