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Oral anticoagulation with vitamin K inhibitors and determinants of successful self-management in primary care

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dc.contributor.author Tamayo Aguirre, Eduardo
dc.contributor.author Galo-Anza, Arrate
dc.contributor.author Dorronsoro-Barandiaran, Olatz
dc.contributor.author Uranga Sáez del Burgo, Edurne
dc.contributor.author Ostiza Irigoyen, Aitziber
dc.contributor.author Garcia-Carro, Alejandro
dc.contributor.author Lopez-Fernandez, Isabel
dc.contributor.author Colera, Nerea
dc.contributor.author Saez Garbayo, P.
dc.contributor.author Tamayo-Uria, Ibon
dc.date.accessioned 2016-11-11T10:37:08Z
dc.date.available 2016-11-11T10:37:08Z
dc.date.issued 2016
dc.identifier.citation Tamayo Aguirre E, Galo-Anza A, Dorronsoro-Barandiaran O, Uranga-Saez del Burgo E, Ostiza Irigoyen A, Garcia-Carro A, Lopez-Fernandez I, Colera N, Saez-Garbayo P, Tamayo-Uria I. Oral anticoagulation with vitamin K inhibitors and determinants of successful self-management in primary care. BMC Cardiovasc Disord. 2016; 16(1):180. DOI: 10.1186/s12872-016-0326-z
dc.identifier.issn 1471-2261
dc.identifier.uri http://hdl.handle.net/10230/27494
dc.description.abstract Background: Self-management may be an option to monitor oral anticoagulant therapy in health systems, but before recommending it, we need to assess patients’ ability to take on this task. The purpose of the study was to describe patients’ ability to self-manage and associated factors. Methods: This was a 3-year prospective quasi-experimental study with a control group. Overall, 333 patients on anticoagulant therapy from seven primary care health centres of the Basque Health Service were included in the intervention group and followed up for 6 months after the intervention, assessing their ability to self-test and self-manage. The intervention consisted of a patient training programme, providing detailed information on their condition and its treatment, and practical training in how to use a portable blood coagulation monitor and adjust their anticoagulant dose. Comparisons were made with a control group (333 patients receiving OAT under usual care from the same seven health centres). Outcome variables were ability to self-manage, quality of the outcome (in terms of time in therapeutic range), and quality of life in the intervention group, and general patient characteristics (age and sex), clinical variables (reason for OAT, INR range), and quality of the outcome (in terms of percentage of INR measurements in range and complications) in both groups. Results: Overall, 26.13 % of patients invited to participate in the intervention agreed. Of these, 99 % successfully learned to self-manage their OAT. Just 4.2 % did not complete the follow-up, in all cases for reasons unrelated to self-management, and 4.5 % required additional learning support. Outcomes were better than under usual care in terms of percentage of INR measurements in range (12 %), rate of complications (4 %) and quality of life (9.2 %). Limitations: Patients were only followed-up period for 6 months and the study was conducted in a single health organization. Though patients eligible to participate were selected randomly, they were not randomly allocated to the groups. This is a potential source of selection bias. Data needed to calculate in-range time were not collected from controls; rather the results for the self-management group were compared with external data from other studies. Conclusions: Almost all participants achieved competency in self-management, with no differences by age, sex, concurrent illnesses, polypharmacy or educational level. The greatest barrier to self-management was the attitude of patients themselves and those around them. Self-management in primary care is a good alternative to usual care, patients having longer times in therapeutic range and fewer complications, and improving their quality of life. Remote management is a good support tool.
dc.description.sponsorship CARLOS III. FIS EXPEDIENT NUMBER - PI11/02285. & FEDER.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartof BMC Cardiovasc Disord. 2016; 16(1):180
dc.rights © 2016 The Author(s). Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.title Oral anticoagulation with vitamin K inhibitors and determinants of successful self-management in primary care
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1186/s12872-016-0326-z
dc.subject.keyword OAT
dc.subject.keyword Self-managemen
dc.subject.keyword Acces
dc.subject.keyword Abilities
dc.subject.keyword Time in therapeutic range
dc.subject.keyword Quality of life
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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