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

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

Self-rated health and factors influencing responses among young Egyptian type 1 diabetes patients

<p>Abstract</p> <p>Background</p> <p>Patients diagnosed with type 1 diabetes mellitus (T1DM) face major daily challenges. Self-rated health (SRH) is a global measure of an individual's health related quality of life (HRQoL) and is based on the question, "In general, how would you rate your health?" Subjects rate their health as excellent, very good, good, poor or very poor. Our objective was to determine the HRQoL using the SRH measure and determine factors influencing responses. We hypothesized that better SRH responses were associated with shorter diabetes duration, better compliance and better glycemic control.</p> <p>Methods</p> <p>The standardized SRH measure was the instrument used for health related quality of life assessment. Logistic regression analysis was used to examine the association between SRH responses and selected variables.</p> <p>Results</p> <p>124 subjects, 64 females (51.6%) and 60 males (48.4%) were included. Average age was 13.08 (±3.19) and average diabetes duration was 5.82 (±1.60), while the mean HbA₁C was 8.02 (±1.60). The majority rated their health as good (31%), 29% rated it as excellent, 11% as very good, 14% as poor and 15% as very poor. Regression analysis showed that regular exercise was the only predictor that was independently and significantly associated with a "better" self-health rating, with an OR of 12.84, CI of 1.425-115.727 and a <it>p </it>value of 0.023.</p> <p>Conclusion</p> <p>Regular exercise among Egyptian children with T1DM is strongly associated with a "better" overall health related quality of life and should be repeatedly encouraged.</p

Prevalence of lipid abnormalities before and after introduction of lipid modifying therapy among Swedish patients with dyslipidemia (PRIMULA)

<p>Abstract</p> <p>Background</p> <p>Data on the prevalence of dyslipidemia and attainment of goal/normal lipid levels in a Swedish population are scarce. The objective of this study is to estimate the prevalence of dyslipidemia and attainment of goal/normal lipid levels in patients treated with lipid modifying therapy (LMT).</p> <p>Methods</p> <p>This longitudinal retrospective observational study covers time periods before and after treatment. Data were collected from 1994-2007 electronic patient records in public primary healthcare centers in Uppsala County, Sweden. Patients were included if they had been treated with LMT and had at least one lipid abnormality indicating dyslipidemia and if complete lipid profile data were available. Thresholds levels for lipids were defined as per Swedish guidelines.</p> <p>Results</p> <p>Among 5,424 patients included, at baseline, the prevalence of dyslipidemia (≥1 lipid abnormality) was by definition 100%, while this figure was 82% at follow-up. At baseline, 60% had elevated low-density lipoprotein (LDL-C) combined with low high-density lipoprotein (HDL-C) and/or elevated triglycerides (TG s), corresponding figure at follow-up was 36%. Low HDL-C and/or elevated TGs at follow-up remained at 69% for patients with type 2 diabetes mellitus (T2DM), 50% among patients with coronary heart disease (CHD) and 66% among patients with 10 year CHD risk >20%. Of the total sample, 40% attained goal levels of LDL-C and 18% attained goal/normal levels on all three lipid parameters.</p> <p>Conclusions</p> <p>Focusing therapy on LDL-C reduction allows 40% of patients to achieve LDL-C goal and helps reducing triglyceride levels. Almost 60% of patients experience persistent HDL-C and/or triglyceride abnormality independently of LDL-C levels and could be candidates for additional treatments.</p

Gout in immigrant groups: a cohort study in Sweden

Our aim was to study the association between country of birth and incidence of gout in different immigrant groups in Sweden. The study population included the whole population of Sweden. Gout was defined as having at least one registered diagnosis in the National Patient Register. The association between incidence of gout and country of birth was assessed by Cox regression, with hazard ratios (HRs) and 95% confidence intervals (95% CI), using Swedish-born individuals as referents. All models were conducted in both men and women, and the full model was adjusted for age, place of residence in Sweden, educational level, marital status, neighbourhood socio-economic status and co-morbidities. The risk of gout varied by country of origin, with highest estimates, compared to Swedish born, in fully adjusted models among men from Iraq (HR 1.82, 95% CI 1.54–2.16), and Russia (HR 1.69, 95% CI 1.26–2.27), and also high among men from Austria, Poland, Africa and Asian countries outside the Middle East; and among women from Africa (HR 2.23, 95% CI 1.50–3.31), Hungary (HR 1.98, 95% CI 1.45–2.71), Iraq (HR 1.76, 95% CI 1.13–2.74) and Austria (HR 1.70, 95% CI 1.07–2.70), and also high among women from Poland. The risk of gout was lower among men from Greece, Spain, Nordic countries (except Finland) and Latin America and among women from Southern Europe, compared to their Swedish counterparts. The increased risk of gout among several immigrant groups is likely explained by a high cardio-metabolic risk factor pattern needing attention