Prospective evaluation of the quality of oral anticoagulation management in an outpatient clinic and in general practices.
OBJECTIVE
To compare the quality of oral anticoagulant therapy (QOAT), before and after referral of patients on oral anticoagulant therapy (OAT) from a hospital outpatient clinic (HOC) to general practitioners (GPs).


METHODS
Prospective observational study. Patients were identified by using the Laboratory Information System (LIS), containing all prescribed International Normalised Ratio of Prothrombin Time (INR) tests, from the HOC and GPs in the hospital submission area.


METHODS
The HOC in a rural hospital, Aarhus County, Denmark (55,000 inhabitants), and GPs in the submission area.


METHODS
124 OAT patients (59.7% males. Median age 70.0: 25-75 percentile: 62.0-76.0).


METHODS
The QOAT in terms of time spent within therapeutic INR interval (TI). The QOAT was compared 8 months before with 8 months after altering the monitoring organization. For patients monitored less than 8 months before the alteration, the QOAT was compared to a corresponding time period after the alteration.


RESULTS
We identified 124 OAT patients, and found a significant increase in the QOAT from 65.0% before to 69.1% after referral of the patients to the GPs (P<.0001). In 75 patients with full follow-up, the QOAT increased from 67.5% before to 69.7% after the alteration (P<.0001).


CONCLUSIONS
The results indicate that the QOAT in this geographical area is adequate, and that the quality performed by the GPs was at least as good as in the HOC. In order to document and increase the QOAT, continuous quality surveillance using the LIS has been initiated.
Holm
Tomas
T
Department of Medicine and Cardiology A, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansensgade 2, DK-8000 Aarhus C, Denmark. tomas.holm@aas.auh.dk
Deutch
Susanna
S
Lassen
Jens F
JF
Jastrup
Birthe
B
Husted
Steen E
SE
Heickendorff
Lene
L
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use*; D003718:Denmark; D019468:Disease Management; D005194:Family Practice / Q000592:standards*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D011446:Prospective Studies; D011517:Prothrombin Time; D011787:Quality of Health Care; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control
D000925:Anticoagulants