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Quality of anticoagulation and use of warfarin-interacting medications in long-term care

Quality of anticoagulation and use of warfarin-interacting medications in long-term care. Madeleine Verhovsek Bahareh Motlagh Mark A Crowther Courtney Kennedy Lisa Dolovich Glenda Campbell Luqi Wang Alexandra Papaioannou. BMC Geriatrics July 2008, 8:13. Background.

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Quality of anticoagulation and use of warfarin-interacting medications in long-term care

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  1. Quality of anticoagulation and use of warfarin-interacting medications in long-term care Madeleine Verhovsek Bahareh Motlagh Mark A Crowther Courtney Kennedy Lisa Dolovich Glenda Campbell Luqi Wang Alexandra Papaioannou BMC Geriatrics July 2008, 8:13

  2. Background • Studies have found that warfarin therapy is generally poorly controlled in community settings • [Arch Intern Med 1994; 154(17), Arch Intern Med 2000; 160(7)] • In long-term care facilities optimal anticoagulation should be achievable: • Availability of laboratory monitoring • Ensured adherence to warfarin therapy • Infrastructure for dose adjustment • Ability to detect all potential medication interactions Verhovsek et al. BMC Geriatrics 2008, 8:13 2

  3. What were the objectives? • Primary Objective • Determine how effectively warfarin was administered to a cohort of residents in LTC facilities • Secondary Objective • Identify the proportion of residents prescribed warfarin-interacting drugs Verhovsek et al. BMC Geriatrics 2008, 8:13

  4. What methods were used? • Chart review of 105 residents in five LTC facilities in Hamilton, Ontario • All residents were on warfarin therapy • Data collected: • INR levels • Warfarin prescribing and monitoring practices • Use of interacting medications Verhovsek et al. BMC Geriatrics 2008, 8:13 4

  5. What are the residents’ characteristics? • Percentage of residents on warfarin – 9% • Gender - 72% female • Mean Age - 83.6 yrs (range 54.7-98.0 yrs) • Mean BMI (kg/m2) - 24.9 (range 14.8-37.9) Verhovsek et al. BMC Geriatrics 2008, 8:13 5

  6. How often were residents in therapeutic range? ≤ 1.5 1.6-1.9 2.0-2.5 2.6-3.0 3.1-3.5 ≥ 3.5 INR: Sub-therapeutic Therapeutic Supra-therapeutic Verhovsek et al. BMC Geriatrics 2008, 8:13 6

  7. What about medication interactions? • 79% of residents (83 residents) • were prescribed at least one • interacting drug during period • of chart audit • Average of 1.8 interacting • medications per resident over • duration of chart review (range • 1-6) • 72 instances of newly initiated • medications or dosage changes • 82% of the time (59/72) INR was checked within ≤7 days after initiation of medication or change in dose 7 Verhovsek et al. BMC Geriatrics 2008, 8:13

  8. What did we conclude? • INR was in therapeutic range 54.1% of time • INR was sub-therapeutic over one-third of time • Majority of residents were on medications known to interact with warfarin • 20% of the time, INR was not measured within ≤7 days after initiation or change in medication dose Verhovsek et al. BMC Geriatrics 2008, 8:13 8

  9. Acknowledgments This work was funded by : • Canadian Institute of Health Research • Medical Pharmacies Group Ltd. • Regional Medical Associates Verhovsek et al. BMC Geriatrics 2008, 8:13

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