title: Quality assessment of oral anticoagulant treatment in the Beer-Sheba district.
abstract: OBJECTIVE
  To evaluate the adequacy of oral anticoagulation therapy in patients with either prosthetic heart valves or atrial fibrillation.
  
  
  METHODS
  Adequacy of anticoagulation therapy of patients treated with warfarin was determined before and after implementation of an improvement programme.
  
  
  METHODS
  The central haematology laboratory of the Soroka Medical Center, Beer-Sheba Israel.
  
  
  METHODS
  One hundred and ten patients treated with chronic anticoagulation therapy were evaluated by measuring the international normalized ratio of the prothrombin time before and after implementation of an improvement plan aimed at improving anticoagulation control.
  
  
  METHODS
  A programme that included physician and patient education and procedural changes covering all aspects of anticoagulation therapy was implemented.
  
  
  METHODS
  The percent of international normalized ratio tests below, within and above the therapeutic range was determined.
  
  
  RESULTS
  Prior to implementation of an improvement plan, only 32% of the measured international normalized ratio values were within the therapeutic range. 16% were above and 52% were below therapeutic range. Improvement intervention led to an increase in the proportion of international normalized ratio tests that fell within the therapeutic range from 32% to 43.2%.
  
  
  CONCLUSIONS
  Improvement in the control of anticoagulation therapy of patients receiving long-term warfarin treatment is possible. A combined effort involving the community, physician and patient is required.
authors.affiliation: Haematology Laboratory and Institute, Soroka Medical Center, Beer-Sheba, Israel. tikva@bgumail.bgu.ac.il
authors.forename: T
authors.initials: T
authors.lastname: Yermiahu
authors.forename: J E
authors.initials: JE
authors.lastname: Arbelle
authors.forename: D
authors.initials: D
authors.lastname: Shwartz
authors.forename: Y
authors.initials: Y
authors.lastname: Levy
authors.forename: N
authors.initials: N
authors.lastname: Tractinsky
authors.forename: A
authors.initials: A
authors.lastname: Porath
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000704:Analysis of Variance; D000925:Anticoagulants / Q000008:administration & dosage* / Q000097:blood; D001281:Atrial Fibrillation / Q000097:blood / Q000188:drug therapy; D016903:Drug Monitoring; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012016:Reference Values; D015912:Thrombolytic Therapy / Q000592:standards*; D017749:Total Quality Management; D014859:Warfarin / Q000008:administration & dosage* / Q000097:blood
chemical_list: D000925:Anticoagulants; D014859:Warfarin