Abstract
BackgroundDetecting, treating and monitoring anaemia has a functional, social and economic impact on patients’ quality of life and the health system, since inadequate monitoring can lead to more accident & emergency visits and hospitalizations. The aim of this study is to evaluate the impact in the patient clinical outcomes of using haemoglobinometry to early detect anaemia in patients with chronic anaemia in primary care.MethodsRandomized controlled trial Capillary haemoglobin will be measured using a haemoglobinometer on a monthly basis in the intervention group. In the control group, the protocol currently in force at the primary care centre will be followed and venous haemoglobin will be measured. Any cases of anaemia detected in either group will be referred to the transfusion circuit of the reference hospital.DiscusionThe results will shed light on the impact of the intervention on the volume of hospitalizations and accident & emergency (A&E) visits due to anaemia, as well as patients’ quality of life. Chronic and repeated bouts of anaemia are detected late, thus leading to decompensation in chronic diseases and, in turn, more A&E visits and hospitalizations. The intervention should improve these outcomes since treatment could be performed without delay. Improving response times would decrease decompensation in chronic diseases, as well as A&E visits and hospitalizations, and improve quality of life. The primary care nurse case manager will perform the intervention, which should improve existing fragmentation between different care levels.Trial registrationNCT04757909. Registered 17 February 2021. Retrospectively registered.
Highlights
Detecting, treating and monitoring anaemia has a functional, social and economic impact on patients’ quality of life and the health system, since inadequate monitoring can lead to more accident & emergency visits and hospitalizations
The World Health Organization defines anaemia as a condition in which haemoglobin (Hb) concentration is lower than 13 g/dl in men and 12 g/dl in women [1, 2]
In asymptomatic patients without cardiovascular risks, transfusion is rarely needed until Hb drops below 7–8 g/dl or haematocrit falls between 21 and 24%, there are some clinical circumstances in which is not recommended to let Hb drop that low for an extended period, or the optimal transfusion strategy is unclear
Summary
Detecting, treating and monitoring anaemia has a functional, social and economic impact on patients’ quality of life and the health system, since inadequate monitoring can lead to more accident & emergency visits and hospitalizations. The aim of this study is to evaluate the impact in the patient clinical outcomes of using haemoglobinometry to early detect anaemia in patients with chronic anaemia in primary care. Many patients with chronic anaemia require periodic transfusions. Several studies recommend making personalized indications for blood transfusions based on the patient’s clinical context, pathologies and preferences rather than exclusively on Hb and haematocrit levels in order to reduce the risks inherent to transfusions. In asymptomatic patients without cardiovascular risks, transfusion is rarely needed until Hb drops below 7–8 g/dl or haematocrit falls between 21 and 24%, there are some clinical circumstances in which is not recommended to let Hb drop that low for an extended period, or the optimal transfusion strategy is unclear. In patients with coronary artery disease, it has been found that a restrictive transfusion strategy (in most cases, with the limit at 9 mg/dl) is linked to a higher risk of experiencing another cardiac ischemic event, while a personalized, liberal transfusion strategy lowers that same risk [7,8,9,10,11], the observed results of a recent clinical trial suggests that there may be merit to a restrictive strategy [7]
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