Comparison of an anticoagulation clinic with usual medical care -: Anticoagulation control, patient outcomes, and health care costs
Comparison of an anticoagulation clinic with usual medical care -: Anticoagulation control, patient outcomes, and health care costs
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DOI：
10.1001/archinte.158.15.1641
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发表时间：
1998-08-10
影响因子：
--
通讯作者：
Bussey, HI
中科院分区：
文献类型：
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作者：
Chiquette, E;Amato, MG;Bussey, HI
背景：在抗凝门诊（AC）观察的初始队列患者的结果先前已发表。该诊所的临时关闭允许对另外两个初始队列进行评估：常规医疗护理和AC。目的：比较接受常规医疗护理和AC治疗的新抗凝患者的患者特征、抗凝控制、出血和血栓栓塞事件以及住院和急诊费用的差异。结果：比率以每患者年的百分比表示。在AC接受低范围抗凝治疗的患者，大于5.0的国际标准化比率较少（7.0% vs 14.7%），在范围内停留的时间较多（40.0% vs 37.0%），大于5的国际标准化比率停留的时间较少（3.5% vs 9.8%）。在AC接受高范围抗凝治疗的患者在范围内的国际标准化比率更多（50.4% vs 35.0%），小于2.0的国际标准化比率较少（13.0% vs 23.8%），并且在范围内停留的时间更长（64.0% vs 51.0%）。AC组显著出血（8.1% vs 35.0%）、大出血到致命性出血（1.6% vs 3.9%）和血栓栓塞事件（3.3% vs 11.8%）的发生率（以每患者年百分比表示）较低；AC组的死亡率也有降低的趋势（0% vs 2.9%； P=.09）。与华法林钠相关的年住院率（5%对19%）和急诊就诊率（6%对22%）显著降低，每100名患者的年医疗保健费用减少了132086美元。此外，与华法林无关的急诊就诊率较低（46.8%对168.0%），每100名患者每年可额外节省医疗费用29972美元。结论：临床药师管理的交流改善了抗凝控制，减少了出血和血栓栓塞事件发生率，每年每100名患者减少住院和急诊就诊，节省了162058美元。
Background: The outcomes of an inception cohort of patients seen at an anticoagulation clinic (AC) were published previously. The temporary closure of this clinic allowed the evaluation of 2 more inception cohorts: usual medical care and an AC.Objective: To compare newly anticoagulated patients who were treated with usual medical care with those treated at an AC for patient characteristics, anticoagulation control, bleeding and thromboembolic events, and differences in costs for hospitalizations and emergency department visits.Results: Rates are expressed as percentage per patient-year. Patients treated at an AC who received lower-range anticoagulation had fewer international normalized ratios greater than 5.0 (7.0% vs 14.7%), spent more time in range (40.0% vs 37.0%), and spent less time at an international normalized ratio greater than 5 (3.5% vs 9.8%). Patients treated at an AC who received higher-range anticoagulation had more international normalized ratios within range (50.4% vs 35.0%), had fewer international normalized ratios less than 2.0 (13.0% vs 23.8%), and spent more time within range (64.0% vs 51.0%). The AC group had lower rates (expressed as percentage per patient-year) of significant bleeding (8.1% vs 35.0%), major to fatal bleeding (1.6% vs 3.9%), and thromboembolic events (3.3% vs 11.8%); the AC group also demonstrated a trend toward a lower mortality rate (0% vs 2.9%; P=.09). Significantly lower annual rates of warfarin sodium-related hospitalizations (5% vs 19%) and emergency department visits (6% vs 22%) reduced annual health care costs by $132 086 per 100 patients. Additionally, a lower rate of warfarin-unrelated emergency department visits (46.8% vs 168.0%) produced an additional annual savings in health care costs of $29 972 per 100 patients.Conclusions: A clinical pharmacist-run AC improved anticoagulation control, reduced bleeding and thromboembolic event rates, and saved $162 058 per 100 patients annually in reduced hospitalizations and emergency department visits.