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. Des ign - Two study periods of 8 weeks were compared with reference to mon itoring sites, i.e. hospital departments and primary health care centr es. Setting - The health care district of Umea in northern Sweden, wit h 125 300 inhabitants. Participants - Patients on oral anticoagulant t herapy at the department of Internal Medicine, Umea University Hospita l, 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=2 90) in the Umea district. Main outcome measures - The prevalence of tr eatment failures and complications was calculated per patient year, as well as the relative frequencies of patients within treatment recomme ndations. Results - 80-83% of the patients were within treatment recom mendations. Treatment failures were 3.6% of hospital patients, and 2.6 % of primary care patients. Corresponding figures for bleeding complic ations were 8.9% and 5.1%, respectively. The differences are partly ex plained by differences in the studied groups, e.g. age, indications fo r treatment, and concomitant diseases.