RESUMO
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Assuntos
Humanos , Masculino , Feminino , Neoplasias/prevenção & controle , Neoplasias Ovarianas/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias da Mama/prevenção & controle , Neoplasias Colorretais/prevenção & controle , Neoplasias Pulmonares/prevenção & controleAssuntos
Neoplasias/prevenção & controle , Neoplasias da Mama/prevenção & controle , Neoplasias Colorretais/prevenção & controle , Feminino , Humanos , Neoplasias Pulmonares/prevenção & controle , Masculino , Neoplasias Ovarianas/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controleRESUMO
BACKGROUND AND OBJECTIVE: The objective of this study was the evaluation of the pilot programme of decentralization of oral anticoagulant therapy (OAT) in eight basic health zones (ZBS) for the first six months and then a year after the programme was put into practice. PATIENTS AND METHOD: Descriptive transversal study. It includes all patients aged 14 years or older in the OAT (540 in the initial period and then 640 more) in eight ZBS (five urban and three rural). The evaluation was done including: prevalence of INR in control (2-3 or 2.5-3.5, according to indications), clinically suitable INR (INR in control +/- 0.2) and INR in control +/- 0.5, accumulated thrombosis and bleeding incidence. Source data: ANTICOAGN computer programme. RESULTS: Comparison of INR control between both periods: 59% against 63.9% of INR in the range of INR in control (p < 0.001), 72.8% against 78.8% for clinically suitable INR (p < 0.001), and 86.6% against 91.4% for INR in control +/- 0.5 (p < 0.001). Accumulated incidence of bleeding episodes in 6 months: Pilot: 1.1% (0.7% majors and 0.4% minors). Subsequent period: 3.6% (0.6% majors and 3% minors). CONCLUSIONS: The decentralization of control of the OAT with adequate resources implies a greater accessibility for the patient. The control of INR is acceptable and has improved significantly over the second period. We have detected an improvement in the increase of the INR below that of the range of the control INR. The incidence of minor hemorrhages has increased, owing probably to a better recording.
Assuntos
Anticoagulantes/administração & dosagem , Avaliação de Programas e Projetos de Saúde , Administração Oral , Adolescente , Adulto , Idoso , Área Programática de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Atenção Primária à Saúde/estatística & dados numéricos , Espanha , Fatores de TempoRESUMO
FUNDAMENTO Y OBJETIVO: El objetivo de este estudio fue evaluar el programa piloto de control descentralizado del tratamiento anticoagulante oral (TAO) en 8 zonas básicas de salud (ZBS) a los6 meses y al año de su puesta en marcha. PACIENTES Y MÉTODO: Estudio descriptivo transversal. Se incluyeron todos los pacientes mayores de14 años que recibían TAO (540 en la prueba piloto y 640 en el período posterior) en estas 8 ZBS(5 urbanos y 3 rurales). Se evaluó la razón normalizada internacional (INR) en el intervalo terapéutico(2-3 o 2,5-3,5, según la indicación), INR en el intervalo terapéutico ± 0,2 e INR en el intervalo terapéutico ± 0,5, incidencia acumulada de hemorragias y de trombosis. Los datos proceden del programa informático ANTICOAGN. Se han analizado mediante Access 97 y el paquete estadístico SPSS 10.0. Para las comparaciones entre porcentajes se ha utilizado la prueba de la χ 2. RESULTADOS: En la comparación de control de la INR entre ambos períodos se observó un 59frente a un 63,9% de INR dentro del intervalo para la INR en el intervalo terapéutico (p <0,001), 72,8 frente a un 78,8% para la INR en el intervalo terapéutico ± 0,2 (p < 0,001) y un86,6 frente a un 91,4% para la INR en el intervalo terapéutico ± 0,5 (p < 0,001). La incidencia acumulada de episodios de hemorragias en 6 meses fue: en la pase piloto del 1,1% (el0,7% mayores y el 0,4% menores) y en el período posterior del 3,6% (un 0,6% mayores y un3% menores). En un año se observó también una incidencia acumulada de episodios de trombosis de 9 casos (el 1,4% de los episodios).CONCLUSIONES: La descentralización del control del TAO con recursos adecuados de apoyo supone un avance en la accesibilidad del paciente. El control de la INR es aceptable y ha mejorado significativamente en el segundo período. Se detecta un área de mejora en el aumento de la INR por debajo del intervalo para la INR en el intervalo terapéutico. Ha aumentado la incidenciade hemorragias menores, probablemente por un mejor registro
BACKGROUND AND OBJECTIVE: The objective of this study was the evaluation of the pilot programme of decentralization of oral anticoagulant therapy (OAT) in eight basic health zones (ZBS) for the first six months and then a year after the programme was put into practice. PATIENTS AND METHOD: Descriptive transversal study. It includes all patients aged 14 years or olderin the OAT (540 in the initial period and then 640 more) in eight ZBS (five urban and three rural).The evaluation was done including: prevalence of INR in control (2-3 or 2.5-3.5, according to indications), clinically suitable INR (INR in control ± 0.2) and INR in control ± 0.5, accumulated thrombosis and bleeding incidence. Source data: ANTICOAGN computer programme. RESULTS: Comparison of INR control between both periods: 59% against 63.9% of INR in the range of INR in control (p < 0.001), 72.8% against 78.8% for clinically suitable INR (p <0.001), and 86.6% against 91.4% for INR in control ± 0.5 (p < 0.001). Accumulated incidence of bleeding episodes in 6 months: Pilot: 1.1% (0.7% majors and 0.4% minors). Subsequent period: 3.6% (0.6% majors and 3% minors).CONCLUSIONS: The decentralization of control of the OAT with adequate resources implies a greater accessibility for the patient. The control of INR is acceptable and has improved significantly over the second period. We have detected an improvement in the increase of the INR below that of the range of the control INR. The incidence of minor hemorrhages has increased, owing probably to a better recording
