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Anticoagulationauditpc

Clinical audit of the management of patients in an
anticoagulant primary care clinic in Ireland
Sarah Molony1, Dr. David Molony2 , Dr. Aisling O’Leary1.
1. School of Pharmacy, Royal College of Surgeons Ireland. 2. The Red House Family Practice, Mallow Primary Healthcare Centre.
Introduction

778,973 prescriptions for warfarin in Ireland (2008) Aim of study
Audit to assess standard of care provided to patients as determined by TTR Atrial fibrillationPulmonary embolism / Deep vein thrombosisPost-valve replacement Secondary objective to undertake an economic assessment of the model of AF associated stroke increases progressively with age RR reduction of stroke with warfarin over aspirin 39% Audit standards
North Dublin Population Stroke Study 2010: BCSH recommendation - 60% TTR (+/- 0.5 units target) <25% of those with known AF anticoagulated with 4 weekly testing for those stabilised (Ansell et al) Models of care
Primary care, secondary care, patient self-testing Protocol development and ICGP Ethical Approval (Nov ’09) Time in therapeutic range (TTR) assessment Inclusion of Rosendaal’s method of linear interpolation Complete GP® Rosendaal linear interpolation method or % time spent in range Study Setting

Primary care anti-coagulant model adopted in 2002 Patient care pathways and proactive audit assessments Clinical audit of the management of patients in an
anticoagulant primary care clinic in Ireland
Sarah Molony1, Dr. David Molony2 , Dr. Aisling O’Leary1.
1. School of Pharmacy, Royal College of Surgeons Ireland. 2. The Red House Family Practice, Mallow Primary Healthcare Centre.
Clinical outcomes
f tx
s o
th
n
o
m
60
166 patients treated with warfarin 2002-2009 Haemorrhagic events st 12r lal fo 40
2009 n=8 (1 major) ensoR 20
Haemorrhagic Event on at least one occassion Haemorrhagic Events
Patient demographics
Conclusion
Simple adjustment to software allowed incorporation of TTR AF 61%, DVT/PE 13%, Post-valve replacement 14.5% TTR in re-audit increased to 61% from 54% (12 months) Cost to practice of managing one GMS AF patient on warfarin Time in Therapeutic Range
Study outcomes
On-going audit to maintain standard of care Flagging system for warfarin patients and at risk patients TTR (12 months)
Point prevalence
INR tests
Dosage adjustment software now incorporated into software Dec 2010 Kelly et al. Stroke Associated with Atrial Fibrillation- Incidence and Early Outcomes in the North Dublin Population Stroke Study. Cerebrovasc Dis 2010;29;43-49Hart et al. Adjusted-dose warfarin verus aspirin for preventing stroke in patients with atrial fibrillation. Ann Intern med. 2007;147;590-2Baglin TP, Keeling DM, Watson HG; British Committee for Standards in Haematology. Guidelines on oral anticoagulation (warfarin): third edition--2005 update. Br J Haematol. 2006 Feb;132(3):277-85.
Baglin TP, Cousins D, Keeling DM, Perry DJ, Watson HG. British Committee for Standards in Haematology and National Patient Safety Agency. Br J Haematol. 2007 Feb;136(4):681.
Ansell J et al (2004). The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference Antithrombotic and Thrombolytic Therapy. Chest 126(suppl),204S-233S. Oppenkowski TP, Murray ET, Sandhar H, Fitzmaurice DA. External quality assessment for warfarin dosing using computerised decision support software. J Clin Pathol. 2003;56:605-607.

Source: http://completegp.ie/papers/AnticoagulationAuditPC.pdf

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