Pell J P, Alcock J
Department of Public Health Sciences, University of Edinburgh.
Br J Gen Pract. 1994 Aug;44(385):357-8.
Hospital anticoagulant clinics are available only in some areas. There is little information on the contribution of general practitioners to oral anticoagulant monitoring, and whether their management varies with access to hospital clinics.
A study was undertaken to compare general practice management of anticoagulant therapy in two health boards with contrasting access to hospital clinics.
A postal questionnaire was sent to the senior partners in all 198 practices in Lothian and Fife, Scotland.
Lack of access to hospital clinics in Lothian health board resulted in more practices reporting taking sole responsibility for anticoagulant control than in Fife where there was access (P < 0.001). However, there was no significant difference in management policies. Overall, 93% of practices used a protocol for thrombotest target ranges, but 75% had no policy on review frequency and only 2% assessed complication or failure rates. Reduced access to hospital clinics was associated with a decreased likelihood of favouring hospital involvement. Sole responsibility for anticoagulant management was undertaken by 56% of general practices, although only 21% of doctors viewed this as ideal. Most general practitioners felt that they should monitor patients on anticoagulant therapy but should refer to hospital those with problematic control.
Access to hospital clinics affected the degree of involvement of general practitioners in oral anticoagulant monitoring, but did not considerably alter their management practice.
医院抗凝门诊仅在部分地区提供。关于全科医生在口服抗凝剂监测中的作用以及他们的管理是否因能否使用医院门诊而有所不同，相关信息较少。
开展一项研究，比较两个卫生委员会中抗凝治疗的全科管理情况，这两个卫生委员会在使用医院门诊方面存在差异。
向苏格兰洛锡安和法夫郡所有198家诊所的高级合伙人发送了邮政调查问卷。
洛锡安卫生委员会无法使用医院门诊，导致报告承担抗凝控制唯一责任的诊所比可以使用医院门诊的法夫郡更多（P < 0.001）。然而，管理政策没有显著差异。总体而言，93%的诊所使用了血栓试验目标范围的方案，但75%没有关于复查频率的政策，只有2%评估了并发症或失败率。使用医院门诊机会减少与支持医院参与的可能性降低相关。56%的全科诊所承担抗凝管理的唯一责任，尽管只有21%的医生认为这是理想的。大多数全科医生认为他们应该监测接受抗凝治疗的患者，但对于控制有问题的患者应该转诊到医院。
使用医院门诊影响了全科医生参与口服抗凝剂监测的程度，但并没有显著改变他们的管理实践。
