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Differences in patient outcomes and chronic care management of oral anticoagulant therapy: an explorative study.

Drewes HW, Lambooij MS, Baan CA, Meijboom BR, Graafmans WC, Westert GP - BMC Health Serv Res (2011)

Bottom Line: 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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: TRANZO, Tilburg University, Tilburg, The Netherlands. hanneke.drewes@rivm.nl

ABSTRACT

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.

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Patient outcomes on the therapeutic range (N = 57). Blue bar shows the percentage of patients within the appropriate therapeutic range per AC region. Red bar shows the percentage of patients below the appropriate therapeutic range per AC region.
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Figure 1: Patient outcomes on the therapeutic range (N = 57). Blue bar shows the percentage of patients within the appropriate therapeutic range per AC region. Red bar shows the percentage of patients below the appropriate therapeutic range per AC region.

Mentions: Results showed that the percentages of patients within and below the therapeutic range varied. Figure 1 visualizes these patient outcomes for each AC region. The number of patients within the appropriate therapeutic range varied between AC regions from 66.7% to 86.8% (mean = 76.8; sd = 5.1). Furthermore, the number of patients below the appropriate therapeutic range varied from 1.8% to 13.4% (mean = 7.8; sd: 2.6) of the patients between the AC regions. The number of patients within the appropriate target range varied from 48.5% to 70.7% (mean = 59.1; sd = 5.8). This implies that the chance to be in the correct target or therapeutic range can be 20% higher in one AC region compared to another.


Differences in patient outcomes and chronic care management of oral anticoagulant therapy: an explorative study.

Drewes HW, Lambooij MS, Baan CA, Meijboom BR, Graafmans WC, Westert GP - BMC Health Serv Res (2011)

Patient outcomes on the therapeutic range (N = 57). Blue bar shows the percentage of patients within the appropriate therapeutic range per AC region. Red bar shows the percentage of patients below the appropriate therapeutic range per AC region.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3040705&req=5

Figure 1: Patient outcomes on the therapeutic range (N = 57). Blue bar shows the percentage of patients within the appropriate therapeutic range per AC region. Red bar shows the percentage of patients below the appropriate therapeutic range per AC region.
Mentions: Results showed that the percentages of patients within and below the therapeutic range varied. Figure 1 visualizes these patient outcomes for each AC region. The number of patients within the appropriate therapeutic range varied between AC regions from 66.7% to 86.8% (mean = 76.8; sd = 5.1). Furthermore, the number of patients below the appropriate therapeutic range varied from 1.8% to 13.4% (mean = 7.8; sd: 2.6) of the patients between the AC regions. The number of patients within the appropriate target range varied from 48.5% to 70.7% (mean = 59.1; sd = 5.8). This implies that the chance to be in the correct target or therapeutic range can be 20% higher in one AC region compared to another.

Bottom Line: 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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: TRANZO, Tilburg University, Tilburg, The Netherlands. hanneke.drewes@rivm.nl

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus