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Warfarin control: paying more for a less safe service; is this really the way forward?
  1. N T J O’Connor
  1. Shrewsbury and Telford Hospital NHS Trust, UK
  1. Dr N T J O’Connor, Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK; nigeshrewsbury{at}hotmail.com

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In 1974 the Royal Shrewsbury Hospital initiated provision of blood testing so that family doctors could advise on warfarin dosing and date of next test. The newly appointed haematologist was so appalled at the number of patients admitted who were bleeding and had unacceptably high international normalised ratios (INRs), that he instituted a hospital-based advice service which has continued to date. Blood samples are taken in the community and sent to the hospital for testing; dosage advice is posted or telephoned to the patient. There are 6198 patients on warfarin—from a catchment population of 500 000. Over the last 18 months government policy has been directed to providing care away from the hospital, to be “closer to the patient”. In early July 2006, one of the general practices we serve unilaterally took back the care of …

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