Coagulation Management Among Migrants Attending Family Practice
DOI: 10.3238/zfa.2014.0409-0414german translation / full article
Background: Coagulation management is complicated and is a challenge for both patients and their family physicians (FPs), particularly when the person receiving care has a migratory background (MB) and speaks German poorly. In this study, we examine whether there is a difference in anticoagulation therapy between patients with and without an MB.
Method: When participants were being recruited for the Primary Care Management for Optimized Antithrombotic Treatment (PICANT) trial, a cluster-randomized clinical study on coagulation management in family practice, information was collected on the indication, type and quality of anticoagulation therapy patients were undergoing. Further data were gathered from the doctors on adherence, immigration status and German language ability. Differences were tested for statistical significance.
Results: Of the 1,757 screened persons, 160 (9.1 %) had a migratory background. Age, gender, indication and anticoagulation therapy were comparable, and 93 % of each group was taking a vitamin K antagonist. Oral anticoagulation (OAC) was indicated and taken by 93 % of persons with and 92 % without an MB. 63 % of migrants and 67 % of non-migrants had values within their therapeutic INR range, and 10 % of each group was performing INR self-management. FPs reckoned patients with a migratory background showed poorer adherence (p = 0.04). The immigrants came from 28 different countries and 60 % spoke German well.
Discussion/Conclusions: The proportion of patients showing under- or overtreatment with oral anticoagulants was low overall and there was no significant difference between the two groups. Despite comparably good results, FPs judged adherence among patients with an MB to be worse. This subjective assessment by FPs should be examined in more detail and possibly taken into account when considering their behavior when providing care.