Quality assessment of oral anticoagulation in Belgium, as practiced by a group of general practitioners

被引:3
作者
Claes, N
Buntinx, F
Vijgen, J
Arnout, J
Vermylen, J
Fieuws, S
Van Loon, H
机构
[1] Catholic Univ Louvain, Dept Gen Practice, B-3000 Louvain, Belgium
[2] Virga Jesse Hosp, Dept Cardiol, Hasselt, Belgium
[3] Catholic Univ Louvain, Ctr Mol & Vasc Biol, B-3000 Louvain, Belgium
[4] Catholic Univ Louvain, Ctr Biostat, B-3000 Louvain, Belgium
关键词
general practitioner; anticoagulation; INR; quality assessment; monitoring of therapy;
D O I
10.2143/AC.60.3.2005000
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective - In Belgium oral anticoagulation therapy is mainly supervised by general practitioners (GPs). This study aims to evaluate the quality of management of oral anticoagulation by Belgian GPs and to verify the relation between time in range and a set of potentially influencing co-variables. Methods - In a retrospective cross-sectional study, involving 66 GP-practices, the INR-values obtained over a 6-month period were analysed. All INR-values were determined by a single clinical laboratory and additional medical information was provided by the GPs. Linear mixed models have been used to model the patient-specific percentage INR in target as a function of different co-variables. Results - 737 patients were included in the study. Patients who underwent a surgical intervention with an interruption of the anticoagulation during the study were excluded. Patients were only included after the initial starting-up period. 5,890 INR-values were obtained. A total of 92,566 days of therapy was evaluated. 50% of the day values were within 0.5 INR-units from target (and 66% within 0.75 INR-units from target). In a multiple regression model, a significant relation between the percentage of time in range and the target INR (2.5 or 3.5) and the gender of the patient was shown. The incidence rate for major bleeding was 5.5/100 patient years (and 3.5/100 patient years for thrombo-embolic events). Conclusion - The quality of management of oral anticoagulation by the GPs in Belgium is suboptimal. It is unknown whether interventions such as guidelines, feedback, point-of-care monitoring and computer-assisted anticoagulation monitoring could improve the results.
引用
收藏
页码:247 / 252
页数:6
相关论文
共 23 条
[1]  
[Anonymous], 1998, BR J HAEMATOL, V101, P374
[2]  
Benavente O, 2000, COCHRANE DB SYST REV, V2, pCD001927
[3]   Monitoring therapy with anticoagulants in The Netherlands [J].
Breukink-Engbers, WGM .
SEMINARS IN THROMBOSIS AND HEMOSTASIS, 1999, 25 (01) :37-42
[4]   OPTIMAL ORAL ANTICOAGULANT-THERAPY IN PATIENTS WITH MECHANICAL HEART-VALVES [J].
CANNEGIETER, SC ;
ROSENDAAL, FR ;
WINTZEN, AR ;
VANDERMEER, FJM ;
VANDENBROUCKE, JP ;
BRIET, E .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (01) :11-17
[5]   Are the results of randomized controlled trials on anticoagulation in patients with atrial fibrillation generalizable to clinical practice? [J].
Evans, A ;
Kalra, L .
ARCHIVES OF INTERNAL MEDICINE, 2001, 161 (11) :1443-1447
[6]   Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing -: A randomized, controlled trial [J].
Fitzmaurice, DA ;
Hobbs, FDR ;
Murray, ET ;
Holder, RL ;
Allan, TF ;
Rose, PE .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (15) :2343-2348
[7]   Do single handed practices offer poorer care? Cross sectional survey of processes and outcomes [J].
Hippisley-Cox, J ;
Pringle, M ;
Coupland, C ;
Hammersley, V ;
Wilson, A .
BRITISH MEDICAL JOURNAL, 2001, 323 (7308) :320-323
[8]  
KOUDSTAAL PJ, 1995, NEW ENGL J MED, V333, P5
[9]   Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism - A meta-analysis [J].
Linkins, LA ;
Choi, PT ;
Douketis, JD .
ANNALS OF INTERNAL MEDICINE, 2003, 139 (11) :893-900
[10]  
Littell RC., 1996, SAS SYSTEM MIXED MOD