Anticoagulant treatment of patients with atrial fibrillation in primary health care.
ABSTRACT To determine the prevalence of anticoagulant (AC) treatment of patients with atrial fibrillation in primary health care. To identify complications in the same patients during 1 year.
Cross-sectional study and 1-year follow-up.
Seven health centres with a total population of 164093.
Five hundred and twenty-two anticoagulated patients with atrial fibrillation.
The age-adjusted prevalence of AC treated patients with atrial fibrillation was 0.30%. Of the 522 patients, 240 were men, mean age 69.6 years; and 282 women, mean age 75.1 years. At the beginning of the study 85% and after 1 year 81% of the latest prothrombin time values were within recommended range. After 1 year 414 out of the 522 patients continued AC treatment. During the 1-year follow-up 62 patients had minor or major complications. Eleven patients (2.1%) had to discontinue AC treatment because of complications. Prothrombin tests were mainly taken at 3-4 week intervals.
High quality AC treatment is possible in the hands of general practitioners.
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ABSTRACT: Objective: Assessing the quality of anticoagulant (AC) treatment in primary health care with regard to safety. Design: Surveys of patients on AC treatment during 1999. Setting: Community health centres (CHCs) in the north-eastern region of Stockholm County. Subjects: Nine hundred and fifty-seven patients, from 16 CHCs. Main outcome measures: Rate of bleeding and thrombo-embolic events during AC treatment and rate of values within the recommended treatment interval. The reporting of prothrombin-time (PT) results changed during the year from PT values to international normalised ratio (INR). Results: A total of 48 bleeding events in 44 patients were noted, i.e. 6.8 per 100 patient-years. Of these, ten were major bleedings, 1.4 per 100 patient-years, including three fatal bleedings, 0.4 per 100 patient-years. Six thrombo-embolic events were noted during treatment, i.e. 0.8 per 100 patient-years. Bleeding events were more common at INR values greater than 2.80 than at values of 2.80, [relative risk (RR) 3.30, 95% confidence interval 1.90-5.71]. Of all the noted PT values, 65% were within the recommended intervals (the most common being PT 15-25%) and of all noted INR values 60% (the most common being INR 2.1-3.0). No differences in the rate of bleeding or the number of thrombo-embolic events between the periods of PT and INR results were found. Conclusions: The rate of complications was low and AC treatment in primary health care seems to be as safe as in hospital clinics.European Journal of Clinical Pharmacology 03/2001; 57(1):61-64. DOI:10.1007/s002280000250 · 2.70 Impact Factor
- FMC - Formación Médica Continuada en Atención Primaria 01/2003; 10(5):323–329. DOI:10.1016/S1134-2072(03)75907-6
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ABSTRACT: In this study we sought to develop a comparative cost evaluation between conventional and new media, e.g. web, mobile communication technology and digital television, and near patient testing supported anticoagulant (ac) treatment follow-up in a primary health care setting. The comparison was done for two patient groups, self-care and home-care patients, on oral ac treatment in the primary health care centre of the rural and sparsely populated municipality of Ikaalinen. In practise case analysis was used to develop cost functions from collected economic data, which were analysed to determine the break-even point in total cost between conventional and new media supported follow-up for the two patient groups. In the home-care setting the break-even point is 14 patients; in the self-care setting new media supported follow-up is always more cost-effective. The results illustrate that the use of new media and near patient testing in ac treatment follow-up brings about an economic benefit even with a small number of patients in the Ikaalinen setting. However, the sensitivity of break-even to perturbations in the individual costs of the used economic models remains high. Still, when the economic benefits are considered together with the clinical and practical benefits shown to result from self-testing, self-management and use of new media technologies the new service models can be said to provide noticeable benefits both in terms of quality of care and economics in our specific setting.International Journal of Medical Informatics 05/2003; 70(1):19-29. DOI:10.1016/S1386-5056(02)00179-X · 2.72 Impact Factor