Anticoagulation management in remote primary care.

OBJECTIVE To examine anticoagulation management at the Bella Coola Medical Clinic in British Columbia. DESIGN Charts of all patients in the Bella Coola Valley receiving warfarin were assessed. Data were analyzed using Microsoft Excel. SETTING Bella Coola Medical Clinic on the remote central coast of British Columbia. PARTICIPANTS Twenty-one patients at the Bella Coola Medical Clinic who were receiving warfarin. MAIN OUTCOME MEASURES All international normalized ratio (INR) tests over the preceding 12 months were examined for results, time elapsed since previous test, and interval until next scheduled test. RESULTS An in-range INR rate of 60% is considered acceptable for anticoagulation services. The clinic had performed 406 INR tests on these 21 patients over the last 12 months. We found that 53% of all INR results fell strictly within the recommended therapeutic range. The relative success of anticoagulation management in Bella Coola probably results from several factors. For instance, physicians usually responded to out-of-range INR results with close monitoring: in 71% of cases, follow-up tests were scheduled within 1 week. On average, patients attended 77% of these visits on schedule; 58% of all out-of-range INR results were followed up with retesting within 1 week. CONCLUSION Our results suggest that primary care physicians can manage anticoagulation adequately, even in remote settings.