rss
J Clin Pathol 2007;60:1263-1267 doi:10.1136/jcp.2006.044008
  • Original article

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

  1. D McCahon1,
  2. E T Murray1,
  3. S Jowett2,
  4. H S Sandhar1,
  5. R L Holder1,
  6. S Hussain1,
  7. B O’Donoghue1,
  8. D A Fitzmaurice1
  1. 1
    Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK
  2. 2
    Health Economics Facility, University of Birmingham, Birmingham, UK
  1. 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
  • Accepted 17 January 2007
  • Published Online First 26 January 2007

Abstract

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.

Footnotes

  • Funding: The Midlands Research Practice Consortium funded the project.

  • Competing interests: None declared.

  • Ethical approval: Approved by the Warwickshire Local Research Ethics Committee.

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

This Article

  1. Abstract
  2. Full text
  3. PDF
  4. All versions of this article:
    1. jcp.2006.044008v1
    2. 60/11/1263 most recent

Responses

  1. Submit a response
  2. No responses published

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.