Research article

Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden

Stina Andersson¹ , Ingela Björholt² , Gunnar H Nilsson³ and Ingvar Krakau⁴

¹AstraZeneca Sverige AB, Södertälje, Sweden

²Institute of Clinical Sciences, Göteborg University, Göteborg, Sweden and Nordic Health Economic Research AB, Göteborg, Sweden

³Neurotec Department, Karolinska Institutet, Stockholm, Sweden

⁴Center of Family Medicine, Karolinska Institutet, Huddinge and Department of Medicine, Solna, Sweden

author email corresponding author email

BMC Family Practice 2006, 7:67doi:10.1186/1471-2296-7-67

Published:	12 November 2006

Abstract

Background

Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment in primary health care in Sweden.

Methods

Delphi technique was used to systematically explore attitudes, demands and priorities, and to collect informed judgements related to monitoring of warfarin treatment. Two separate Delphi-panels were performed in three and two rounds, respectively, one concerning tests taken in primary health care centres, involving 34 GPs and 10 registered nurses, and one concerning tests taken in patients' homes, involving 49 district nurses.

Results

In the primary health care panel 10 of the 34 GPs regularly collaborated with a registered nurse. Average time for one monitoring episode was estimated to 10.1 minutes for a GP and 21.4 minutes for a nurse, when a nurse assisted a doctor. The average time for monitoring was 17.6 minutes for a GP when not assisted by a nurse. Considering all the monitoring episodes, 11.6% of patient blood samples were taken in the individual patient's home. Average time for such a monitoring episode was estimated to 88.2 minutes. Of all the visits, 8.2% were performed in vain and took on average 44.6 minutes. In both studies, approximately 20 different elements of work concerning management of patients during warfarin treatment were identified.

Conclusion

Monitoring of patients during treatment with warfarin in primary health care in Sweden involves many elements of work, and demands large resources, especially when tests are taken in the patient's home.