Anticoagulation management in remote primary care.
OBJECTIVE
To examine anticoagulation management at the Bella Coola Medical Clinic in British Columbia.


METHODS
Charts of all patients in the Bella Coola Valley receiving warfarin were assessed. Data were analyzed using Microsoft Excel.


METHODS
Bella Coola Medical Clinic on the remote central coast of British Columbia.


METHODS
Twenty-one patients at the Bella Coola Medical Clinic who were receiving warfarin.


METHODS
All international normalized ratio (INR) tests over the preceding 12 months were examined for results, time elapsed since previous test, and interval until next scheduled test.


RESULTS
An in-range INR rate of 60% is considered acceptable for anticoagulation services. The clinic had performed 406 INR tests on these 21 patients over the last 12 months. We found that 53% of all INR results fell strictly within the recommended therapeutic range. The relative success of anticoagulation management in Bella Coola probably results from several factors. For instance, physicians usually responded to out-of-range INR results with close monitoring: in 71% of cases, follow-up tests were scheduled within 1 week. On average, patients attended 77% of these visits on schedule; 58% of all out-of-range INR results were followed up with retesting within 1 week.


CONCLUSIONS
Our results suggest that primary care physicians can manage anticoagulation adequately, even in remote settings.
Nast
Shauna L
SL
University of British Columbia, Vancouver.
Tierney
Martin J
MJ
McIlwain
Ray
R
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy; D001955:British Columbia; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data*; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin