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Warfarin control: paying more for a less safe service - is this really the way forward?
  1. Nigel O'Connor (nigeshrewsbury{at}
  1. Royal Shrewsbury Hospital, United Kingdom


    In 1974 our Hospital provided blood tests 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 bleeding with an unacceptably high INR he instituted a hospital-based advice service which has continued to date. Blood samples are taken in the community and sent in on a routine transport for testing, then dosage advice is posted or telephoned to the patient. There are 6,198 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 hospital, as it is "closer to the patient".

    • commissioning
    • cost
    • inr testing
    • safety
    • warfarin

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