Variability in the control of Oral Anticoagulant Therapy between Primary Care and Hospital inAlbacete (2009)

Abstract

Background: After taking control of oral anticoagulant therapy in our health center it became necessary to detect possible differences with regard to hospital monitoring. The aim of our study was to determine the variability in the International Normalized Ratio (INR) values of patients on oral anticoagulant therapy (OAT), and the possible relation to control in primary care or hospital. Methods:We analyzed the last 6 controls of 291 patients in an urban health centre in routine control by OAT. In order to analyze the variability, we calculated the standard deviation (SD) of natural logarithm (ln) of INR values, comparing by Student t test theirmean between patients whose treatment had been scheduled in primary care and those on some occasions ruled by them and others in hospital.We compared also the proportion of controls within range in each group (chi2). Results: 153 (52.6%) patients were women, and the mean age was 73.8 years (SD: 11.3).We analyzed a total of 1710 INR controls, of which 1412 have been validated by family physicians and 298 by haematologists; there were no significant differences in INR values. Patients whose treatment had been scheduled by professionals of the health centre had mean values of the SD of the ln of the INR of 6 controls analyzed significantly lower (p <0.0001) than in those who had taken a mixed control. Also, a higher proportion of controls within range (68.0% vs 38.6%, p <0.0001). Conclusions: Patients who are followed only by professionals in the health centre have less variability and more appropriate INR control than those with a mixed control health centre / hospital.