Author/Editor     Jeretina, Petra
Title     Kakovost antikoagulacijskega zdravljenja bolnikov s kronično atrijsko fibrilacijo v antikoagulacijski ambulanti ZD Litija
Translated title     The quality of anticoagulation management of patients with atrial fibrillation in a family phisician's practice in Litija
Type     monografija
Publisher     Medicinska fakulteta
Publication year     2004
Volume     str. 17
Language     slo
Abstract     The number of patients on long-term anticoagulation therapy with coumarines has steeply increased. The known reason for this increase is a new therapeutical indication: atrial fibrillation without accompanying valve damage. The specialist outpatient's clinics could not take care for all the patients any more, so clinics on primary health care level for the management of such patients were established. In the Health centre Litija we started such a clinic at the begining of 2002. We stick to the guidelines prepared at the outpatient clinic in Ljubljana. In this article the quality of anticoagulation therapy in our clinic was assessed. The quality of anticoagulation therapy management is reflected by TTR (time in therapeutic range), which expresses the proportion of INR values within the therapeutic range - between 2.0 and 3.0. In this article the most important factors that might influence the INR stability are described. The results of two six-month periods were compared. The aim was to answer the question if continual patients' education about their illness can improve the quality of anticoagulation management. After the first six months a lecture was carried out (intervention). We continued to educate our patients over the next six months. A main enhance of TTR after intervention was not achieved (from 0.56 to 0.59). 1n the first six months 5 haemorrhagic events were noted (5%) and in the second six months there were 2 (2%). In one case sending to the hospital was needed and in two cases vitamin K was administered. We did not notice any trombembolic event. Good cooperation between the patient's physician and the physician who manages the anticoagulation therapy leads to better outcomes.
Summary     Število bolnikov, ki potrebujejo antikoagulacijsko zdravljenje je zaradi novo sprejete indikacije atrijske fibrilacije brez spremljajoče okvare srčnih zaklopk - v zadnjih letih močno naraslo. Specialistične ambulante so postale preobremenjene, zato se je del vodenja antikoagulacijskega zdravljenja s sekundarne ravni prenesel na primarno raven zdravstvenega varstva. V ZD Litija smo z delom v antikoagulacijski ambulanti pričeli v začetku leta 2002. Bolnike obravnavamo v skladu s priporočili Dispanzerja za trombotične bolezni v Ljubljani. V svoji nalogi sem ocenila kakovost zdravljenja v naši ambulanti. Merilo kakovosti antikoagulacije predstavlja TTR (time in therapeutic range), ki pomeni delež meritev INR v terapevtskem območju - med 2.0 in 3.0. Opisala sem najpogostejše vzroke, ki vplivajo na variabilnost rezultatov antikoagulacijskega zdravljenja. Da bi odgovorila na vprašanje, ali lahko kontinuirano poučevanje bolnikov o njihovi bolezni in zdravljenju izboljša kakovost zdravljenja, sem primerjala rezultate dveh šestmesečnih obdobij. Po prvem obdobju sem bolnikom pripravila predavanje o antikoagulacijskem zdravljenju (intervencija) in v naslednjih mesecih nadaljevala izobraževanje ob kontrolnih obiskih v ambulanti. Vrednost TTR, ki je pred intervencijo znašala 0.56, se po intervenciji ni bistveno povečala (0.59). V prvih 6 mesecih je krvavitev utrpelo 5% bolnikov, v drugem šestmesečju pa 2%. V enem primeru je bila potrebna napotitev v bolnišnico, dva bolnika sta zaradi iztirjenih vrednosti INR prejela K vitamin. Tromemboličnega zapleta v času raziskave nismo zabeležili. Za uspešno in varno antikoagulacijsko zdravljenje je poleg bolnikovega sodelovanja pomembno tudi dobro sporazumevanje med bolnikovim osebnim zdravnikom in zdravnikom v antikoagulacijski ambulanti.
Descriptors     ATRIAL FIBRILLATION
ANTICOAGULANTS
FAMILY PRACTICE
PROTHROMBIN TIME
QUALITY CONTROL