Developing of warfarin clinic management system Udon thani hospital and hospitals network

Abstract

Objective :This research was aimed to developing of Warfarin clinic management system Udon Thani hospital and hospitals network. Materials & methods : the cross-sectional descriptive study was used SWOT Matrix, 6 Building Blocks and creating of Warfarin’s guideline, data collected in February 2018. Population & samples : include 282 samples were Patients and 30 personnel. Tools employed to collected was used personnel questionnaire, patient evaluation form and service record fiscal year 2015-2016. Analysis using percentages means, standard deviation and summary analysis triangulation and qualitative data of content analysis. Results : Participation of multidisciplinary warfarin clinic during 2015-2016 with the help of Udon Thani Hospital 96.7%, Brainstorming 93.3% and participation in process 90.0% respectively. Cause of illness found most patients with ACS (Acute coronary syndrome) 88.7%, IHD (ischemic heart disease) 9.2% and CAD (coronary heart disease) were 2.1%, female 81.2%, age 60 years and over 52.8% (mean59.52,11.07SD), good BMI 100%, bad blood pressure (≥ 140/90) 66.7%, HbA1c (≥ 7%) 71.3%, cholesterol ( < 200mg/dl) 54.6%, LDL (≥ 100 mg/dl) 58.5%, HDL (< 40mg/dl) 51.1%, INR (2-3.5 in target) 57.4%, INR(< 2.0, risk of thrombosis) 29.1% and INR (> 3.5) 13.5% risk of major bleeding respectively. Risk assessment factor of Thromboembolism was low risk 51.1%, most of the patients were diabetic 51.1%, during age 65-74 years 20.6% and hypertension 12.8% respectively. Overall risk of bleeding was 79.4%, from Labile INR 45.0%, Stroke 19.9%, age over 65 years was 11.7%. Warfarin clinic service during fiscal year 2015 – 2016 was achieve 6 criteria include coverage of patients receiving warfarin was 85.26% and 94.32% respectively (increase 9.06%), coverage of 99% and 99.0% of eligible patients with Warfarin clinic (Cardio medicine), patients knowledge about warfarin were 80.36% and 82.75% (increase 2.39%), good compliance 81.93% and 92.48% (increase 10.55%), major bleeding 0.41% and 0.32 (decrease 0.09), minor bleeding 4.41% and 3.62% (decrease 0.79%), but not achieve criteria were patient coverage and eligibility for Warfarin clinic and INR in target. Conclusion : This research founding the developing of Warfarin clinic management system Udon Thani hospital and hospitals network was patient effect of INR in target increased, but not achieve the criteria.