Oral anticoagulant treatment in a medical care district--a descriptive study.
OBJECTIVE
To describe how oral anticoagulant therapy is performed in a defined catchment area in order to improve the quality of care.


METHODS
Two study periods of 8 weeks were compared with reference to monitoring sites, i.e. hospital departments and primary health care centres.


METHODS
The health care district of Umeå in northern Sweden, with 125,300 inhabitants.


METHODS
Patients on oral anticoagulant therapy at the department of Internal Medicine, Umeå University Hospital, in 1987 (n = 243) were compared with all patients treated in 1990 at health centres (n = 175) and at the department of Internal Medicine (n = 290) in the Umeå district.


METHODS
The prevalence of treatment failures and complications was calculated per patient year, as well as the relative frequencies of patients within treatment recommendations.


RESULTS
80-83% of the patients were within treatment recommendations. Treatment failures were 3.6% of hospital patients, and 2.6% of primary care patients. Corresponding figures for bleeding complications were 8.9% and 5.1%, respectively. The differences are partly explained by differences in the studied groups, e.g. age, indications for treatment, and concomitant diseases.
Jansson
J H
JH
Department of Internal Medicine, Skellefteå Hospital, Sweden.
Westman
G
G
Boman
K
K
Nilsson
T
T
Norberg
B
B
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003374:Coumarins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D019035:Rural Health Services; D013548:Sweden; D013923:Thromboembolism / Q000139:chemically induced / Q000188:drug therapy; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000925:Anticoagulants; D003374:Coumarins; D014859:Warfarin; C030123:coumarin