Effect of distance to health facility on the maintenance of INR therapeutic ranges in rheumatic heart disease patients from Cape Town: No evidence for an association

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dc.contributor.authorBarth, Dylan Dominic
dc.contributor.authorZühlke, Liesl
dc.contributor.authorJoachim, Alexia
dc.contributor.authorHoegger, Tyler
dc.contributor.authorMayosi, Bongani M
dc.contributor.authorEngel, Mark E
dc.date.accessioned2015-06-08T12:50:23Z
dc.date.available2015-06-08T12:50:23Z
dc.date.issued2015-06-01
dc.description.abstractBackground: Lack of adherence to international normalised ratio (INR) monitoring in rheumatic heart disease (RHD) patients is a contributor to cardio-embolic complications. This population-based observational study investigated whether the distance between home and an INR clinic affects the maintenance of therapeutic INR in RHD patients on warfarin. Methods: Residential addresses, INR clinics, and INR results of patients with RHD were extracted from the Cape Town component of the Global Rheumatic Heart Disease Registry (REMEDY) database. Addresses of homes and INR clinics were converted to geographical coordinates and verified in ArcGIS 10®. ArcGIS 10® and Google Maps® were used for spatial mapping and obtaining shortest road distances respectively. The travel distance between the home and INR clinic was correlated with time within therapeutic range (TTR) using the Rosendaal linear interpolation method, and with the fraction of INR within range, based on an average of three INR readings of patients and compared with recommended therapeutic ranges. Results: RHD patients (n=133) resided between 0.2 km and 50.8 km (median distance, 3.60 km) from one of 33 INR clinics. There was no significant difference in the achievement of the therapeutic INR between patients who travelled a shorter distance compared to those who travelled a longer distance (in range = 3.50 km versus out of range = 3.75 km, p=0.78). This finding was the same for patients with mechanical valve replacement (n=105) (3.50 km versus 3.90 km, p=0.81), and native valves (3.45 km versus 2.75 km, p=0.84). Conclusions: There is no association between the maintenance of INR within therapeutic range amongst RHD patients in Cape Town and distance from patients’ residence to the INR clinic.en_ZA
dc.identifier.apacitationBarth, D. D., Zühlke, L., Joachim, A., Hoegger, T., Mayosi, B. M., & Engel, M. E. (2015). Effect of distance to health facility on the maintenance of INR therapeutic ranges in rheumatic heart disease patients from Cape Town: No evidence for an association. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/13057en_ZA
dc.identifier.chicagocitationBarth, Dylan Dominic, Liesl Zühlke, Alexia Joachim, Tyler Hoegger, Bongani M Mayosi, and Mark E Engel "Effect of distance to health facility on the maintenance of INR therapeutic ranges in rheumatic heart disease patients from Cape Town: No evidence for an association." <i>BMC Health Services Research</i> (2015) http://hdl.handle.net/11427/13057en_ZA
dc.identifier.citationBarth, D.D., et al. (2015). Effect of distance to health facility on the maintenance of INR therapeutic ranges in rheumatic heart disease patients from Cape Town: No evidence for an association. BMC Health Services Research, 15: 219en_ZA
dc.identifier.ris TY - Journal Article AU - Barth, Dylan Dominic AU - Zühlke, Liesl AU - Joachim, Alexia AU - Hoegger, Tyler AU - Mayosi, Bongani M AU - Engel, Mark E AB - Background: Lack of adherence to international normalised ratio (INR) monitoring in rheumatic heart disease (RHD) patients is a contributor to cardio-embolic complications. This population-based observational study investigated whether the distance between home and an INR clinic affects the maintenance of therapeutic INR in RHD patients on warfarin. Methods: Residential addresses, INR clinics, and INR results of patients with RHD were extracted from the Cape Town component of the Global Rheumatic Heart Disease Registry (REMEDY) database. Addresses of homes and INR clinics were converted to geographical coordinates and verified in ArcGIS 10®. ArcGIS 10® and Google Maps® were used for spatial mapping and obtaining shortest road distances respectively. The travel distance between the home and INR clinic was correlated with time within therapeutic range (TTR) using the Rosendaal linear interpolation method, and with the fraction of INR within range, based on an average of three INR readings of patients and compared with recommended therapeutic ranges. Results: RHD patients (n=133) resided between 0.2 km and 50.8 km (median distance, 3.60 km) from one of 33 INR clinics. There was no significant difference in the achievement of the therapeutic INR between patients who travelled a shorter distance compared to those who travelled a longer distance (in range = 3.50 km versus out of range = 3.75 km, p=0.78). This finding was the same for patients with mechanical valve replacement (n=105) (3.50 km versus 3.90 km, p=0.81), and native valves (3.45 km versus 2.75 km, p=0.84). Conclusions: There is no association between the maintenance of INR within therapeutic range amongst RHD patients in Cape Town and distance from patients’ residence to the INR clinic. DA - 2015-06-01 DB - OpenUCT DO - 10.1186/s12913-015-0890-4 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Effect of distance to health facility on the maintenance of INR therapeutic ranges in rheumatic heart disease patients from Cape Town: No evidence for an association TI - Effect of distance to health facility on the maintenance of INR therapeutic ranges in rheumatic heart disease patients from Cape Town: No evidence for an association UR - http://hdl.handle.net/11427/13057 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/13057
dc.identifier.urihttp://dx.doi.org/10.1186/s12913-015-0890-4
dc.identifier.vancouvercitationBarth DD, Zühlke L, Joachim A, Hoegger T, Mayosi BM, Engel ME. Effect of distance to health facility on the maintenance of INR therapeutic ranges in rheumatic heart disease patients from Cape Town: No evidence for an association. BMC Health Services Research. 2015; http://hdl.handle.net/11427/13057.en_ZA
dc.languageengen_ZA
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_ZA
dc.rights.urihttp://www.biomedcentral.com/bmchealthservres
dc.sourceBMC Health Services Researchen_ZA
dc.source.urihttp://www.biomedcentral.com/bmchealthservres
dc.titleEffect of distance to health facility on the maintenance of INR therapeutic ranges in rheumatic heart disease patients from Cape Town: No evidence for an associationen_ZA
dc.typeJournal Articleen_ZA
uct.subject.keywordsGISen_ZA
uct.subject.keywordsINRen_ZA
uct.subject.keywordsRHDen_ZA
uct.subject.keywordsDistance Decayen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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