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Implementation and outcome evaluation of satellite network of Anticoagulation clinics in Nakornratchasima province, Thailand

บัญชา สุขอนันตชัย; อุบลวรรณ สะพู; อรุณี ทรัพย์สินวิวัฒน์; วิจิน พงษ์ฤทธิ์ศักดา; นันทิยา ตั้งศรีเสรี; สิทธิพงษ์ กนกหงส์; Buncha Sukanantachai; Ubonwan Sapoo; Arunee Supsinwiwat; Wijin Pongrithsakda; Nuntiya Tangsriseree; Sittipong Kanokhong;
Date: 2554-12
Abstract
Background: Anticoagulation clinic has been implemented in Thailand with considerable success, mostly in tertiary care hospitals. To improve accessibility of such service, a satellite network of anticoagulation clinics in rural area was recently implemented. Objective: To compare quality of anticoagulant control, complications and follow-up frequency among patient receiving warfarin therapy during their attendance to a tertiary care center versus after referral to satellite clinics. Methods: Satellite network of anticoagulation clinic was established at the Nakornratchasima province in early 2009 comprising of 4 community hospitals and a community medical unit. Patients receiving warfarin for at least 6 months at a tertiary care hospital, who were clinically stable, were consented and enrolled in satellite clinics. Data on anticoagulation control and other outcome variable of pre-referral period were compared with those of post-referral period using descriptive statistics, paired T-test and McNemar’s test, where appropriate. Results: Sixty nine patients were enrolled with a total number of 273 visits. Mean age was 56.2 ± 13.7 years old. Most common indications were prosthetic valve replacement (40.6 %), rheumatic heart disease (20.2 %), atrial fibrillation with stroke (17.3%) and other (21.7 %). For anticoagulation control, time in target range of patients during pre-referral and post-referral periods were similar (46.5 % vs 46.1 %; p = 0.94). Incidence of INR value < 1.5 or > 4.0 were similar between the two groups but numerically lower in the post-referral period (20.0 % in pre-referral vs 17.2 % in post referral periods: p=0.25). No major complication was reported. Follow-up interval was shorter with satellite clinics (4.5 week/visit and 8.5 week/ visit). Conclusion: Satellite network of anticoagulation clinic can provide quality anticoagulation control similar to a tertiary care setting. In addition, such service may improve safety of warfarin therapy through a close monitoring system and improved accessibility.
Copyright ผลงานวิชาการเหล่านี้เป็นลิขสิทธิ์ของสถาบันวิจัยระบบสาธารณสุข หากมีการนำไปใช้อ้างอิง โปรดอ้างถึงสถาบันวิจัยระบบสาธารณสุข ในฐานะเจ้าของลิขสิทธิ์ตามพระราชบัญญัติสงวนลิขสิทธิ์สำหรับการนำงานวิจัยไปใช้ประโยชน์ในเชิงพาณิชย์
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