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Patient self management of oral anticoagulation in routine care in the UK

¹ Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK
² Health Economics Facility, University of Birmingham, Birmingham, UK

Correspondence to:
Professor David Fitzmaurice, Department of Primary Care and General Practice, Primary Care and Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; d.a.fitzmaurice{at}bham.ac.uk

Background: Self management of anticoagulation: a randomised trial (SMART) was the first large scale UK trial to assess clinical and cost effectiveness of patient self management (PSM) of oral anticoagulation therapy compared to routine care. SMART showed that while PSM was as clinically effective as routine care, it was not as cost effective. SMART adds to the growing body of trial data to support PSM; however there are no data on clinical effectiveness and cost of PSM in routine care.

Aim: To evaluate clinical effectiveness of PSM compared to routine care outside trial conditions.

Methods: A retrospective multicentre matched control study. 63 PSM patients from primary care in the West Midlands were matched by age and international normalised ratio (INR) target with controls. INR results were collected for the period 1 July 2003–30 June 2004. The primary outcome measure was INR control.

Results: 38 PSM and 40 control patients were recruited. INR percentage time in range was 70% PSM vs 64% controls. 60% PSM were having a regular clinical review, 45% were performing an internal quality control (IQC) test and 82% were performing external quality assurance (EQA) on a regular basis.

Conclusion: PSM outside trial conditions is as clinically effective as routine UK care.

Abbreviations: EQA, external quality assurance; GP, general practitioner; INR, international normalised ratio; IQC, internal quality control; POC, point of care; PSM, patient self management