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 Umeå in northern Sweden, with 125,300 inhabitants. PARTICIPANTS: Patients on oral anticoagulant therapy at the department of Internal Medicine, Umeå 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 Umeå 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.