OBJECTIVE: To compare the quality of oral anticoagulant therapy (QOAT), before and after referral of patients on oral anticoagulant therapy (OAT) from a hospital outpatient clinic (HOC) to general practitioners (GPs). DESIGN: Prospective observational study. Patients were identified by using the Laboratory Information System (LIS), containing all prescribed International Normalised Ratio of Prothrombin Time (INR) tests, from the HOC and GPs in the hospital submission area. SETTING: The HOC in a rural hospital, Aarhus County, Denmark (55,000 inhabitants), and GPs in the submission area. SUBJECTS: 124 OAT patients (59.7% males. Median age 70.0: 25-75 percentile: 62.0-76.0). MAIN OUTCOME MEASURE: The QOAT in terms of time spent within therapeutic INR interval (TI). The QOAT was compared 8 months before with 8 months after altering the monitoring organization. For patients monitored less than 8 months before the alteration, the QOAT was compared to a corresponding time period after the alteration. RESULTS: We identified 124 OAT patients, and found a significant increase in the QOAT from 65.0% before to 69.1% after referral of the patients to the GPs (P<.0001). In 75 patients with full follow-up, the QOAT increased from 67.5% before to 69.7% after the alteration (P<.0001). CONCLUSION: The results indicate that the QOAT in this geographical area is adequate, and that the quality performed by the GPs was at least as good as in the HOC. In order to document and increase the QOAT, continuous quality surveillance using the LIS has been initiated.
OBJECTIVE: To compare the quality of oral anticoagulant therapy (QOAT), before and after referral of patients on oral anticoagulant therapy (OAT) from a hospital outpatient clinic (HOC) to general practitioners (GPs). DESIGN: Prospective observational study. Patients were identified by using the Laboratory Information System (LIS), containing all prescribed International Normalised Ratio of Prothrombin Time (INR) tests, from the HOC and GPs in the hospital submission area. SETTING: The HOC in a rural hospital, Aarhus County, Denmark (55,000 inhabitants), and GPs in the submission area. SUBJECTS: 124 OATpatients (59.7% males. Median age 70.0: 25-75 percentile: 62.0-76.0). MAIN OUTCOME MEASURE: The QOAT in terms of time spent within therapeutic INR interval (TI). The QOAT was compared 8 months before with 8 months after altering the monitoring organization. For patients monitored less than 8 months before the alteration, the QOAT was compared to a corresponding time period after the alteration. RESULTS: We identified 124 OATpatients, and found a significant increase in the QOAT from 65.0% before to 69.1% after referral of the patients to the GPs (P<.0001). In 75 patients with full follow-up, the QOAT increased from 67.5% before to 69.7% after the alteration (P<.0001). CONCLUSION: The results indicate that the QOAT in this geographical area is adequate, and that the quality performed by the GPs was at least as good as in the HOC. In order to document and increase the QOAT, continuous quality surveillance using the LIS has been initiated.
Authors: Daniel M Witt; Robby Nieuwlaat; Nathan P Clark; Jack Ansell; Anne Holbrook; Jane Skov; Nadine Shehab; Juliet Mock; Tarra Myers; Francesco Dentali; Mark A Crowther; Arnav Agarwal; Meha Bhatt; Rasha Khatib; John J Riva; Yuan Zhang; Gordon Guyatt Journal: Blood Adv Date: 2018-11-27