scholarly journals Quality of oral anticoagulation in patients with atrial fibrillation: A cross-sectional study in general practice

2006 ◽  
Vol 12 (4) ◽  
pp. 163-168 ◽  
Author(s):  
Claes Neree
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Oral Anticoagulation ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Time in Therapeutic Range, Quality of Life and Treatment Satisfaction of Patients on Long-Term Warfarin for Non-Valvular Atrial Fibrillation: A Cross-Sectional Study

2020 ◽  
Author(s):  
Diana-Leh-Ching Ng ◽  
Natasya Marliana Bt Abdul Malik ◽  
Chee-Shee Chai ◽  
Greta-Miranda-Kim-Choo Goh ◽  
Seng-Beng Tan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Treatment Satisfaction ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Significant Difference

Abstract Background:The use of warfarin in patients with non-valvular atrial fibrillation (NVAF) can be challenging. In this study, we evaluate the time in therapeutic range (TTR), health-related quality of life (HRQoL) and treatment satisfaction of patients on long-term warfarin for NVAF. The HRQoL and treatment satisfaction were compared based on the TTR.Methods:A cross-sectional study was conducted among patients on warfarin for NVAF who attended the anticoagulant clinic of a tertiary cardiology referral center in Sarawak from 1st June 2018 to 31st May 2019. Patients’ TTR was calculated by using Rosendaal technique, while their HRQoL and treatment satisfaction were assessed by using Short Form 12 Health Survey version 2 (SF12v2) and Duke Anticoagulant Satisfaction Scale (DASS), respectively. Results: A total of 300 patients were included, with mean TTR score of 47.0 ± 17.3%. The physical component summary (PCS) and mental component summary (MCS) score of SF-12v2 were 47.0 ± 9.0 and 53.5 ± 9.6, respectively. The total score for DASS was 55.2 ± 21.3, while the score for limitations (L), hassles and burdens (H&B) and positive psychological impacts (PPI) were 18.0 ± 10.0, 15.6 ± 9.1 and 21.6 ± 5.9, respectively. Seventy-three (24.3%) patients had good TTR (≥ 60%), with mean of 70.2 ± 8.7%; while 227 (75.5%) patients with poor TTR had significantly lower mean of 39.5 ± 11.9% (p = 0.006). There was no significant difference in the score of PCS (p = 0.150), MCS (p = 0.919) and each domain of SF-12v2 (p = 0.184 – 0.684) between good and poor TTR, except for social functioning (p = 0.019). The total DASS score was also not significantly different between group (p = 0.779). Similar non-significant difference was also reported in all the DASS sub dimensions (p = 0.502 – 0.699).Conclusions:Majority of the patients on long-term warfarin for NVAF in the current study have poor TTR. Their HRQoL and treatment satisfaction are independent of their TTR. Achieving a good TTR do not compromise the HRQoL and treatment satisfaction. Therefore, appropriate measures should be taken to optimise INR control, failing which direct oral anticoagulant therapy should be considered.

scholarly journals The quality of COPD care in German general practice—A cross-sectional study

2020 ◽  
Vol 17 ◽  
pp. 147997312096481
Author(s):  
Stefan Heinmüller ◽  
Emmily Schaubroeck ◽  
Luca Frank ◽  
Anina Höfle ◽  
Michael Langer ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Of Care ◽  
Pneumococcal Vaccination ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Network

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a common health problem to be dealt with in primary care. Little is known about the quality of care provided for patients with COPD in Germany. Therefore, we wanted to assess the current quality of care delivered by a primary care network (PCN) for patients with COPD. Methods: A cross-sectional study was conducted in collaboration with a primary care network (PCN). All patients of the PCN aged 40 years and older with a diagnosis of COPD were identified through electronic health records (EHR). A set of quality indicators (QIs) developed in accordance with current COPD-guidelines were appraised through numerical data retrieved from the EHR. Results: In total, 2,568 patients with COPD were identified. Their mean age was 67 (SD±12) years, 49% were male. Thirty-five percent had a parallel diagnosis of asthma. There was no documentation of any spirometry for 54% of patients; 29% had a spirometry within the previous year. An influenza vaccination was documented for 37% within the preceding 12 months; 12% received a pneumococcal vaccination in the last 6 years. Smoking status was documented for 44% within the last year. Conclusion: The quality of care for patients with COPD in the PCN seemed suboptimal, despite the presence of a Disease Management Program (DMP). This finding is likely to apply widely to German general practice. Quality assessment through currently available EHR data was challenging due to non-standardized and insufficient documentation.

scholarly journals Clinical governance as professional self-reflection: A cross-sectional study assessing the quality of COPD care in German general practice

2019 ◽  
Author(s):  
Stefan Heinmüller ◽  
Luca Frank ◽  
Anina Höfle ◽  
Michael Langer ◽  
Korbinian Saggau ◽  
...  
Keyword(s):  
General Practice ◽  
Cross Sectional Study ◽  
Clinical Governance ◽  
Care Quality ◽  
Sectional Study ◽  
Negative Effects ◽  
Cross Sectional ◽  
Bottom Up ◽  
Copd Patients

Abstract BACKGROUND In the United Kingdom, a system of clinical governance (CG) which was introduced “top-down” by politics tries to ensure high quality health services. In general practice, the meeting of quality targets was linked to financial incentives causing several negative effects. In Germany CG is not established. We advocate a “bottom-up” CG for German general practice to avoid these negative effects. AIMS To test “bottom-up” CG within a network of general practices (GPN) using chronic obstructive pulmonary disease (COPD) as example disease. As a first step, we wanted to assess the current care quality of the GPN for COPD. Furthermore, feasibility of a care quality assessment through routine data from electronic health records (EHR) should be evaluated. METHODS A cross-sectional study was conducted. Quality indicators (QI) were developed according to COPD guidelines. COPD patients of the GPN ≥40 years were identified. For the determination of QI, data were retrieved from EHR. RESULTS In total, 2568 COPD patients were identified. Their mean age was 67 (SD±12) years, 49% were male. Thirty-five percent had a parallel diagnosis of asthma. There was no documentation of any spirometry for 54% of patients, 29% had a spirometry within the previous year. An influenza vaccination was administered to 37% within the preceding twelve months, 12% received a pneumococcal vaccination in the last six years. Smoking status was documented for 44% within the last year. Several QI were not assessable. CONCLUSION Care quality assessment by means of EHR data was challenging due to non-standardized documentation. Assessable QI indicated suboptimal COPD care. Our results confirm the need for CG in German general practice and better EHR softwares supporting CG through structured documentation and feedback for GPs. We are planning to proceed with “bottom-up” CG by introducing quality improvement measures within the GPN in answer to this study.

scholarly journals Time in Therapeutic Range, Quality of Life and Treatment Satisfaction of Patients on Long-Term Warfarin for Non-Valvular Atrial Fibrillation: A Cross-Sectional Study

2020 ◽  
Author(s):  
Diana-Leh-Ching Ng ◽  
Natasya Marliana Bt Abdul Malik ◽  
Chee-Shee Chai ◽  
Greta-Miranda-Kim-Choo Goh ◽  
Seng-Beng Tan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Treatment Satisfaction ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Significant Difference

Abstract Background: The use of warfarin in patients with non-valvular atrial fibrillation (NVAF) can be challenging. In this study, we evaluate the time in therapeutic range (TTR), health-related quality of life (HRQoL) and treatment satisfaction of patients on long-term warfarin for NVAF. The HRQoL and treatment satisfaction were compared based on the TTR.Methods: A cross-sectional study was conducted among patients on warfarin for NVAF who attended the anticoagulant clinic of a tertiary cardiology referral center in Sarawak from 1st June 2018 to 31st May 2019. Patients’ TTR was calculated by using Rosendaal technique, while their HRQoL and treatment satisfaction were assessed by using Short Form 12 Health Survey version 2 (SF12v2) and Duke Anticoagulant Satisfaction Scale (DASS), respectively. Results: A total of 300 patients were included, with mean TTR score of 47.0 ± 17.3%. The physical component summary (PCS) and mental component summary (MCS) score of SF-12v2 were 47.0 ± 9.0 and 53.5 ± 9.6, respectively. The total score for DASS was 55.2 ± 21.3, while the score for limitations (L), hassles and burdens (H&B) and positive psychological impacts (PPI) were 18.0 ± 10.0, 15.6 ± 9.1 and 21.6 ± 5.9, respectively.Seventy-three (24.3%) patients had good TTR (≥ 60%), with mean of 70.2 ± 8.7%; while 227 (75.5%) patients with poor TTR had significantly lower mean of 39.5 ± 11.9% (p = 0.006). There was no significant difference in the score of PCS (p = 0.150), MCS (p = 0.919) and each domain of SF-12v2 (p = 0.184 – 0.684) between good and poor TTR, except for social functioning (p = 0.019). The total DASS score was also not significantly different between group (p = 0.779). Similar non-significant difference was also reported in all the DASS sub dimensions (p = 0.502 – 0.699).Conclusions: Majority of the patients on long-term warfarin for NVAF in the current study have poor TTR. Their HRQoL and treatment satisfaction are independent of their TTR. Achieving a good TTR do not compromise the HRQoL and treatment satisfaction. Therefore, appropriate measures should be taken to optimise INR control, failing which direct oral anticoagulant therapy should be considered.

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