Improving anticoagulation therapy using point-of-care testing and a standardized protocol

Annals of Family Medicine
Curtis A FrankePeter J Carek

Abstract

Many patients in primary care require anticoagulation with warfarin for the prevention of venous and systemic embolism. Achieving the goal international normalized ratio (INR) with warfarin is challenging. The purpose of this quality improvement initiative was to increase the proportion of patients taking warfarin with an INR value within the goal range. We included all patients identified on an anticoagulation log in the family medicine residency practice during 3 time periods: baseline, after point-of-care (POC) testing was initiated (intervention period 1), and after a standardized warfarin-dosing protocol was implemented (intervention period 2). Educational sessions were conducted during each intervention period. Measures included the frequency of INR monitoring and the percentage of office visits in which patients' values were within the goal INR range. Data were analyzed using descriptive statistics, the Student t test, and the chi2 test. At baseline, patients had an average of 2.6 INR tests performed, and 30.8% were within the INR goal range. Using POC testing, the frequency of monitoring increased to 4.3 INR tests per patient (P = .04), but the percentage of patients within the INR goal remained low at 32.1% (P=.88). Wh...Continue Reading

References

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Citations

Feb 9, 2012·The American Journal of the Medical Sciences·Marcus SmithRhett Jackson
Mar 20, 2012·Thrombosis Research·Ann-Helen KristoffersenSverre Sandberg
Feb 18, 2010·Geriatric Nursing·Denise Bockwoldt
Apr 14, 2016·British Journal of Haematology·David A FitzmauriceUNKNOWN GARFIELD-AF Investigators
Oct 17, 2014·American Journal of Clinical Pathology·J Benjamin CrockerKent Lewandrowski
Apr 12, 2019·Critical Reviews in Clinical Laboratory Sciences·Khushbu Patel, Brenda B Suh-Lailam
Oct 23, 2019·The Journal of Applied Laboratory Medicine·Alan H B Wu, Jill Sellers
Sep 4, 2012·Journal of Graduate Medical Education·Peter J CarekTerrence E Steyer
Aug 24, 2017·Clinica Chimica Acta; International Journal of Clinical Chemistry·Elizabeth-Lee LewandrowskiKent Lewandrowski

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