title: [Quality control of oral anticoagulant therapy in Primary Care in Madrid City, Spain: CHRONOS-TAO study].
abstract: OBJECTIVE
  To determine quality control of patients with oral anticoagulant treatment recruited in Primary Care (PC) using the Rosendaal method to estimate time in therapeutic range (TTR) and comparing it with fraction of international normalized ratio (INR) in range and cross-sectional analysis (last INR registred).
  
  
  METHODS
  A retrospective observational study based on electronic medical record in routine clinical practice.
  
  
  METHODS
  PC centers (262) in Madrid. We included all patients with acenocumarol treatment, with an INR therapeutic range established between 2 and 3. We excluded patients with valvular pathology and disrupted clinical follow up in PC (<3 INR determinations in the studied period, a period of>90 days or ≥ 3 periods of>60 days between 2 determinations). The final population was 49,312 patients. The variables considered were all INR values and their respective dates. TTR was calculated by the 3 methods above mentioned. We considered "therapeutic range" INR between 2-3 and "adjusted range" INR between 1.8-3.2. Optimal control for each patient was considered TTR>60%.
  
  
  RESULTS
  By using Rosendaal method, TTR was 66.8% (81.7% adjusted), with a percentage of total INR in range was 58.8% (66.5% adjusted), and, with the cross-sectional analysis, it was 70.5% (76.8% adjusted). Mean TTR was 65% (standard deviation 20.3), and the percentage of patients with TTR>60% was 63.3% (88.1% adjusted).
  
  
  CONCLUSIONS
  The quality control of patients with oral anticoagulants in PC in Madrid is acceptable, similar or higher to other studies and pivotal trials of new anticoagulants. Compared to the Rosendaal method, total fraction of INR underestimates quality control, and cross-sectional analysis slightly overestimates it.
authors.affiliation: Centro de Salud Griñón, Área Sur, Madrid, España. Electronic address: alonsorocarafael@gmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Alonso Roca
authors.affiliation: Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España.
authors.forename: Carmen Arlene
authors.initials: CA
authors.lastname: Figueroa Guerrero
authors.affiliation: Médico de familia y residente Psiquiatría, Instituto Psiquiátrico José Germain, Leganés, Madrid, España.
authors.forename: Victoria
authors.initials: V
authors.lastname: Mainar de Paz
authors.affiliation: Médico de familia, Centro de Salud Maqueda, Área Centro, Madrid, España.
authors.forename: M Paz
authors.initials: MP
authors.lastname: Arribas García
authors.affiliation: Médico de familia, Dirección Técnica de Sistemas de Información, Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Madrid, España.
authors.forename: Luis
authors.initials: L
authors.lastname: Sánchez Perruca
authors.affiliation: Médico de familia, Unidad de Apoyo a la Investigación, Gerencia Adjunta de Planificación y Calidad, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rodríguez Barrientos
authors.affiliation: Médico de familia, Dirección Técnica de Sistemas de Información, Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Madrid, España.
authors.forename: Mariano
authors.initials: M
authors.lastname: Casado López
authors.affiliation: Especialista en Medicina Preventiva, Hospital Central de la Defensa Gómez Ulla, Madrid, España.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Pedraza Flechas
mesh_terms: D000074:Acenocoumarol / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000592:standards; D004363:Drug Utilization; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011786:Quality Control; D012189:Retrospective Studies; D013030:Spain; D019851:Thrombophilia / Q000188:drug therapy* / Q000453:epidemiology; D014504:Urban Health; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000074:Acenocoumarol
keywords: Anticoagulantes; Anticoagulants; Atención Primaria; Grado de control; International normalized ratio; Primary Care; Quality control; Razón normalizada internacional