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Eftirlit með blóðþynningarmeðferð á Heilbrigðisstofnun Þingeyinga : gæðastjórnunarverkefni

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Authors
Valur Helgi Kristinsson
Issue Date
2005-09-01

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Other Titles
Managing warfarin treatment in a small Icelandic rural practice in Húsavík
Citation
Læknablaðið 2005, 91(9):657-60
Abstract
OBJECTIVE: To investigate the efficiency of warfarin management in Húsavík Health Care Center. MATERIAL AND METHODS: All patients receiving warfarin treatment managed in Húsavík in the years 2001 and 2003 were included in the study. Main outcome measures were the percentage time within INR target range (Rosendaal) and whether the management was deemed satisfactory or unsatisfactory (defined as <3 measurements per year). RESULTS: In 2001 there were 34 patients receiving warfarin treatment in Húsavík but 57 in 2003. Median age was 71.5 and 76 years, 65% and 67% were males, indication for treatment was atrial fibrillation in 53% and 73% and INR target range was 2.0-3.0 in 74% and 86% respectively. The management was deemed unsatisfactory in 38.2% in 2001 but 10.5% in 2003 (27.7% absolute reduction, p=0.0017). Percentage time spent within target range was 61.2% and 63.1% respectively. CONCLUSION: These findings suggest that the quality of anticoagulant control in Húsavík is adequate and fully comparable with that shown in previous studies from our neighbouring countries.
Tilgangur: Að athuga hversu vel gengi að stýra blóðþynningarmeðferð með warfaríni frá Heil­brigðisstofnun Þingeyinga (HÞ) samanborið við aðrar rannsóknir og hvort breytingar sem urðu á framkvæmd eftirlitsins árið 2002 hefðu orðið til bóta. Niðurstöður: Árið 2001 voru 34 sjúklingar á blóðþynningarmeðferð sem stýrt var frá HÞ en 57 árið 2003. Miðgildi aldurs var 71,5 og 76 ár, karlar voru 22 (65%) og 38 (67%). Ábending meðferðar var gáttatif í 53% og 73% tilvika og markgildi INR var 2-3 í 74% og 86% tilvika. Árið 2001 voru 13 af 34 sjúklingum (38,2%) undir ófullnægjandi eftirliti en árið 2003 voru þeir 6 af 57 (10,5%). Munurinn var því 27,7% (p=0,0017). Sjúklingarnir voru 61,2% og 63,1% tímans innan markgildis og meðal mæl­ingafjöldi var sex árið 2001 en 12 árið 2003. Eitt tilvik blóðtappa í heila var árið 2001 og eitt tilvik blæðingar sem krafðist innlagnar árið 2003. Ályktanir: Stjórnun blóðþynningarmeðferðar á HÞ er sambærileg því sem gerist erlendis og betur gengur að halda sjúklingum á meðferð í fullnægjandi eftirliti eftir að breytt var um fyrirkomulag.
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