[Evaluation of the pilot programme for the descentralization of control of oral anticoagulant treatment in the Osasunbidea Healthcare Service (Navarra, Spain)].
OBJECTIVE
The objective of this study was the evaluation of the pilot programme of decentralization of oral anticoagulant therapy (OAT) in eight basic health zones (ZBS) for the first six months and then a year after the programme was put into practice.


METHODS
Descriptive transversal study. It includes all patients aged 14 years or older in the OAT (540 in the initial period and then 640 more) in eight ZBS (five urban and three rural). The evaluation was done including: prevalence of INR in control (2-3 or 2.5-3.5, according to indications), clinically suitable INR (INR in control +/- 0.2) and INR in control +/- 0.5, accumulated thrombosis and bleeding incidence. Source data: ANTICOAGN computer programme.


RESULTS
Comparison of INR control between both periods: 59% against 63.9% of INR in the range of INR in control (p < 0.001), 72.8% against 78.8% for clinically suitable INR (p < 0.001), and 86.6% against 91.4% for INR in control +/- 0.5 (p < 0.001). Accumulated incidence of bleeding episodes in 6 months: Pilot: 1.1% (0.7% majors and 0.4% minors). Subsequent period: 3.6% (0.6% majors and 3% minors).


CONCLUSIONS
The decentralization of control of the OAT with adequate resources implies a greater accessibility for the patient. The control of INR is acceptable and has improved significantly over the second period. We have detected an improvement in the increase of the INR below that of the range of the control INR. The incidence of minor hemorrhages has increased, owing probably to a better recording.
Nuin Villanueva
M Angeles
MA
Sección de Evaluación y Calidad Asistencial de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain. mnuinvil@cfnavarra.es
Arroyo Aniés
M Pilar
MP
Yurss Arruga
Ignacio
I
Granado Hualde
Ana
A
Calvo Herrado
Concepción
C
Elía Pitillas
Fernando
F
Ayerdi Navarro
Karmele
K
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002391:Catchment Area, Health; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D013030:Spain; D013997:Time Factors
D000925:Anticoagulants