ORAL ANTICOAGULANT TREATMENT IN A MEDICAL-CARE DISTRICT - A DESCRIPTIVE STUDY

Objective - To describe how oral anticoagulant therapy is performed in a defined catchment area in order to improve the quality of care. Design - Two study periods of 8 weeks were compared with reference to monitoring sites, i.e. hospital departments and primary health care centres. Setting - The health care district of Umea in northern Sweden, with 125 300 inhabitants. Participants - Patients on oral anticoagulant therapy at the department of Internal Medicine, Umea University Hospital, in 1987 (n=243) were compared with all patients treated in 1990 at health centres (n=175) and at the department of Internal Medicine (n=290) in the Umea district. Main outcome measures - The prevalence of treatment failures and complications was calculated per patient year, as well as the relative frequencies of patients within treatment recommendations. Results - 80-83% of the patients were within treatment recommendations. Treatment failures were 3.6% of hospital patients, and 2.6% of primary care patients. Corresponding figures for bleeding complications were 8.9% and 5.1%, respectively. The differences are partly explained by differences in the studied groups, e.g. age, indications for treatment, and concomitant diseases.