Quality assessment of oval anticoagulant treatment in the Beer-Sheba district

Objective. To evaluate the adequacy of oral anticoagulation therapy in pati ents with either prosthetic heart valves or atrial fibrillation. Design. Adequacy of and coagulation therapy of patients treated with warfar in was determined before and after implementation of an improvement program me. Setting. The central haematology laboratory of the Soroka Medical Center, B eer-Sheba Israel. Study participants. One hundred and ten patients treated with chronic antic oagulation therapy! mere evaluated by measuring the international normalize d ratio of the prothrombin time before and after implementation of an impro vement plan aimed at improving anticoagulation control. Intervention. A programme that included physician and patient education and procedural changes covering all aspects of anticoagulation therapy was imp lemented. Main outcome measure. The percent of international normalized ratio tests b elow within and above the therapeutic range was determined. Results. Prior to implementation of an improvement plan, only 32% of the me asured international normalized ratio values were within the therapeutic ra nge. 16% were above and 52% were below therapeutic range, improvement inter vention led to an increase in the proportion of international normalized ra tio tests that fell within the therapeutic range from 32% to 43.2%. Conclusions. Improvement in the control of anticoagulation therapy) of pati ents receiving long-term warfarin treatment is possible. A combined effort involving the community physician and patient is required.