Hodge Kathleen, Janus Edward, Sundararajan Vijaya, Taylor Sally, Brand Wendy, Ibrahim Joseph E, Wolff Alan
Wimmera Health Care Group, Horsham, Victoria.
Aust Fam Physician. 2008 Apr;37(4):280-3.
Oral anticoagulation management is difficult in rural settings because of reduced patient access to pathology testing and medical management. Previous research reports the effectiveness of coordinated anticoagulation management incorporating education, point of care international normalised ratio (INR) testing, patient self care models, protocols and use of specially trained personnel. This article presents findings on the assessment of a Victorian rural program using a modified anticoagulation clinic and other strategies to improve anticoagulation management.
This program assessed multiple strategies including comprehensive patient education, protocols and point of care INR testing. These were implemented in a rural hospital and rural general practices. Specific measures for evaluation were time in the therapeutic INR range and complication rate.
Time in the therapeutic INR range was 69% for the standard range (2.0-3.0) and 81% using an expanded range (1.8-3.0). The anticoagulation related complication rate was 0.03 per patient year (95% CI: 0.01, 0.06). International normalised ratio testing every 14 days resulted in 78% of time spent in therapeutic range.
The strategies employed in the study increased time spent in therapeutic range and reduced anticoagulation related complications.
在农村地区，由于患者进行病理检查和医疗管理的机会减少，口服抗凝治疗管理存在困难。先前的研究报告了采用教育、即时国际标准化比值（INR）检测、患者自我护理模式、方案以及使用经过专门培训的人员等方式进行协调抗凝管理的有效性。本文介绍了对维多利亚州农村项目的评估结果，该项目采用了改良的抗凝门诊和其他策略来改善抗凝管理。
该项目评估了多种策略，包括全面的患者教育、方案以及即时INR检测。这些策略在一家农村医院和农村全科诊所实施。评估的具体指标为处于治疗性INR范围内的时间和并发症发生率。
标准范围（2.0 - 3.0）下处于治疗性INR范围内的时间为69%，使用扩大范围（1.8 - 3.0）时为81%。抗凝相关并发症发生率为每年每患者0.03（95%置信区间：0.01，0.06）。每14天进行一次国际标准化比值检测，结果显示78%的时间处于治疗范围内。
该研究采用的策略增加了处于治疗范围内的时间，并降低了抗凝相关并发症的发生率。
