Related Experiment Videos
Differences in patient outcomes and chronic care management of oral anticoagulant therapy: an explorative study
Hanneke W Drewes1, Mattijs S Lambooij, Caroline A Baan
1TRANZO, Tilburg University, Tilburg, The Netherlands. hanneke.drewes@rivm.nl
Insights
Improving oral anticoagulant therapy quality can reduce hospitalizations. This study found that better chronic care management in Dutch anticoagulant clinics correlated with improved patient outcomes, suggesting its potential to enhance therapy effectiveness.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Health Services Research
Background:
- Oral anticoagulant therapy (OAT) is crucial for preventing thrombosis but linked to significant avoidable hospitalizations.
- Enhancing OAT quality may reduce drug-related hospital admissions.
- Variations in chronic care management (CCM) within OAT services warrant investigation.
Purpose of the Study:
- To compare patient outcomes across Dutch anticoagulant clinic (AC) regions.
- To explore if CCM elements can improve OAT quality and patient outcomes.
- To assess the impact of CCM variations on OAT effectiveness.
Main Methods:
- A nationwide questionnaire (100% response rate) surveyed ACs in the Netherlands (2008) on CCM elements, operationalized using Wagner's Chronic Care Model.
- Patient outcome data were obtained from the Dutch National Network of ACs.
- Statistical analysis explored associations between CCM, patient orientation, staffing (nurses vs. doctors), and patient outcomes.
Main Results:
- Significant variation in patient outcomes existed, with therapeutic range achievement varying from 67% to 87% across AC regions.
- Differences in CCM implementation were observed, including multidisciplinary meetings (12% of ACs) and hospital agreements (58% of ACs).
- Patient outcomes positively correlated with patient orientation, nurse-to-doctor ratios, and the overall application of CCM elements (p < 0.05).
Conclusions:
- Substantial disparities in both patient outcomes and CCM practices were identified in Dutch OAT services.
- A positive association was found between the extent of CCM application and improved patient outcomes.
- Further research is necessary to elucidate the specific mechanisms through which CCM influences OAT effectiveness.
Background:
The oral anticoagulant therapy - provided to prevent thrombosis - is known to be associated with substantial avoidable hospitalization. Improving the quality of the oral anticoagulant therapy could avoid drug related hospitalizations. Therefore, this study compared the patient outcomes between Dutch anticoagulant clinic (AC) regions taking the variation in chronic care management into account in order to explore whether chronic care management elements could improve the quality of oral anticoagulant therapy.
Methods:
Two data sources were combined. The first source was a questionnaire that was send to all ACs in the Netherlands in 2008 (response = 100%) to identify the application of chronic care management elements in the AC regions. The Chronic Care Model of Wagner was used to make the concept of chronic care management operational. The second source was the report of the Dutch National Network of ACs which contains patient outcomes of the ACs.
Results:
Patient outcomes achieved by the ACs were good, yet differences existed; for instance the percentage of patients in the appropriate therapeutic ranges varied from 67 to 87% between AC regions. Moreover, differences existed in the use of chronic care management elements of the chronic care model, for example 12% of the ACs had multidisciplinary meetings and 58% of the ACs had formal agreements with at least one hospital within their region. Patient outcomes were significantly associated with patient orientation and the number of specialized nurses versus doctors (p-values < 0.05). Furthermore, the overall extent to which chronic care management elements were applied was positively associated with patient outcomes (p-values < 0.05).
Conclusions:
Substantial differences in the patient outcomes as well as chronic care management of oral anticoagulant therapy existed. Since our results showed a positive association between overall application of chronic care management and patient outcomes, additional research is needed to fully understand the working mechanism of chronic care management.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:30Venous Thrombosis IV: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care