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Patient self management of oral anticoagulation in routine care in the UK
  1. Deborah McCahon (d.mccahon{at}bham.ac.uk)
  1. Department of Primary Care and General Practice,University of Birmingham, United Kingdom
    1. Ellen T Murray (e.t.murray{at}bham.ac.uk)
    1. Department of Primary Care and General Practice, University of Birmingham, United Kingdom
      1. Sue Jowett (s.jowett{at}bham.ac.uk)
      1. Health Services Management Centre, The University of Birmingham, United Kingdom
        1. Hardeep S Sandhar (h.s.sandar{at}bham.ac.uk)
        1. Department of Primary Care and General Practice, University of Birmingham, United Kingdom
          1. Roger Holder (r.l.holder{at}bham.ac.uk)
          1. Department of Primary Care and General Practice, University of Birmingham, United Kingdom
            1. Shakir Hussain (s.hussain{at}bham.ac.uk)
            1. Department of Primary Care and General Practice, University of Birmingham, United Kingdom
              1. Barry O'Donoghue (bod{at}doctors.org.uk)
              1. Department of Primary Care and General Practice, University of Birmingham, United Kingdom
                1. David Fitzmaurice (d.a.fitzmaurice{at}bham.ac.uk)
                1. Department of Primary Care and General Practice, University of Birmingham, United Kingdom

                  Abstract

                  Background: Self management of anticoagulation: a randomised trial (SMART) was the first large scale UK trial to assess clinical and cost effectiveness of PSM of oral anticoagulation therapy compared to routine care. SMART demonstrated that whilst 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.

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

                  Methods: A retrospective multi centred 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 01/07/03 – 30/06/04. The primary outcome measure was INR control.

                  Results: 38 PSM and 40 control patients were recruited. INR percentage time in range was 70% PSM v 64% control. 60% PSM were having a regular clinical review, 45% were performing an Internal Quality Control (IQC) and 82% External Quality Assurance (EQA) on a regular basis.

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

                  • International Normalised Ratio,
                  • oral anticoagulation
                  • routine care
                  • self management,
                  • warfarin

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