Coordinated anticoagulation management in a rural setting.
BACKGROUND
Oral anticoagulation management is difficult in rural settings because of reduced patient access to pathology testing and medical management. Previous research reports the effectiveness of coordinated anticoagulation management incorporating education, point of care international normalised ratio (INR) testing, patient self care models, protocols and use of specially trained personnel. This article presents findings on the assessment of a Victorian rural program using a modified anticoagulation clinic and other strategies to improve anticoagulation management.


METHODS
This program assessed multiple strategies including comprehensive patient education, protocols and point of care INR testing. These were implemented in a rural hospital and rural general practices. Specific measures for evaluation were time in the therapeutic INR range and complication rate.


RESULTS
Time in the therapeutic INR range was 69% for the standard range (2.0-3.0) and 81% using an expanded range (1.8-3.0). The anticoagulation related complication rate was 0.03 per patient year (95% CI: 0.01, 0.06). International normalised ratio testing every 14 days resulted in 78% of time spent in therapeutic range.


CONCLUSIONS
The strategies employed in the study increased time spent in therapeutic range and reduced anticoagulation related complications.
Hodge
Kathleen
K
Wimmera Health Care Group, Horsham, Victoria. hodge@whcg.org.au
Janus
Edward
E
Sundararajan
Vijaya
V
Taylor
Sally
S
Brand
Wendy
W
Ibrahim
Joseph E
JE
Wolff
Alan
A
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy; D001315:Australia; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D011517:Prothrombin Time; D011655:Pulmonary Embolism / Q000188:drug therapy; D019035:Rural Health Services; D013923:Thromboembolism / Q000139:chemically induced / Q000517:prevention & control; D020246:Venous Thrombosis / Q000188:drug therapy; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin