This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (53)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Primary Care/ Family Medicine  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

A Randomized, Controlled Trial

David A. Fitzmaurice, MD; F. D. Richard Hobbs, FRCGP; Ellen T. Murray, MSc; Roger L. Holder, BSc; Teresa F. Allan, MSc; Peter E. Rose, MD

Arch Intern Med. 2000;160:2343-2348.

Background  There is increased pressure on primary care physicians to monitor oral anticoagulation.

Objective  To test the null hypothesis that oral anticoagulation care can be provided at least as well in primary care through a nurse-led clinic, involving near-patient testing and computerized decision support software, compared with routine hospital management based on a variety of clinical outcome measures.

Methods  A randomized, controlled trial in 12 primary care practices in Birmingham, England (9 intervention and 3 control). Two control populations were used: patients individually randomly allocated as controls in the intervention practices (intrapractice controls) and all patients in control practices (interpractice controls). Intervention practices' patients were randomized to the intervention (practice-based anticoagulation clinic) or control (hospital clinic) group. The main outcome measure was therapeutic control of the international normalized ratio.

Results  Three hundred sixty-seven patients were recruited (122 intervention patients, 102 intrapractice control patients, and 143 interpractice control patients). Standard measures of control of the international normalized ratio (point prevalence) showed no significant difference between the intervention and control groups. Data on proportion of time spent in the international normalized ratio range showed significant improvement for patients in the intervention group (paired t test, P = .008).

Conclusions  Nurse-led anticoagulation clinics can be implemented in novice primary care settings by means of computerized decision support software and near-patient testing. Care given by this model is at least as good as routine hospital follow-up. The model is generalizable to primary health care centers operating in developed health care systems.

From the Department of General Practice, Medical School, The University of Birmingham, Birmingham, England (Drs Fitzmaurice and Hobbs, Mss Murray and Allan, and Mr Holder); and Pathology Department, Warwick Hospital, Warwick, England (Dr Rose).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Consensus Needed for Evaluating Safe and Adequate Anticoagulant Control
Fiona Taylor and Shah Ebrahim
Arch Intern Med. 2001;161(12):1558.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effect of an interactive voice response system on oral anticoagulant management
Oake et al.
CMAJ 2009;180:927-933.
ABSTRACT | FULL TEXT  

Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation: A Systematic Review
Wan et al.
Circ Cardiovasc Qual Outcomes 2008;1:84-91.
ABSTRACT | FULL TEXT  

Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis
Oake et al.
CMAJ 2008;179:235-244.
ABSTRACT | FULL TEXT  

Best practice in primary care pathology: review 8
Smellie et al.
J. Clin. Pathol. 2007;60:740-748.
ABSTRACT | FULL TEXT  

The Belgian Improvement Study on Oral Anticoagulation Therapy: a randomized clinical trial
Claes et al.
Eur Heart J 2005;26:2159-2165.
ABSTRACT | FULL TEXT  

Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review
Garg et al.
JAMA 2005;293:1223-1238.
ABSTRACT | FULL TEXT  

Therapeutic Update on the Prevention and Treatment of Venous Thromboembolism
McGuire and Dobesh
Journal of Pharmacy Practice 2004;17:289-307.
ABSTRACT  

Antithrombotic and Thrombolytic Therapy: From Evidence to Application: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Schunemann et al.
Chest 2004;126:688S-696S.
ABSTRACT | FULL TEXT  

Anticoagulation
Fitzmaurice
CMAJ 2004;170:447-450.
FULL TEXT  

General practitioners with special clinical interests: Evidence for effectiveness exists
Fitzmaurice
BMJ 2003;327:933-933.
FULL TEXT  

Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study
Howard et al.
Qual Saf Health Care 2003;12:280-285.
ABSTRACT | FULL TEXT  

External quality assessment for warfarin dosing using computerised decision support software
Oppenkowski et al.
J. Clin. Pathol. 2003;56:605-607.
ABSTRACT | FULL TEXT  

ABC of antithrombotic therapy: Anticoagulation in hospitals and general practice
Blann et al.
BMJ 2003;326:153-156.
FULL TEXT  

A systematic review of outcome measures reported for the therapeutic effectiveness of oral anticoagulation
Fitzmaurice et al.
J. Clin. Pathol. 2003;56:48-51.
ABSTRACT | FULL TEXT  

A randomised controlled trial of patient self management of oral anticoagulation treatment compared with primary care management
Fitzmaurice et al.
J. Clin. Pathol. 2002;55:845-849.
ABSTRACT | FULL TEXT  

Point-of-care testing: no pain, no gain
Murphy and Paterson
QJM 2001;94:571-573.
FULL TEXT  

Anticoagulation in patients with thromboembolic disease
Tait
Thorax 2001;56:ii30-37.
FULL TEXT  

Consensus Needed for Evaluating Safe and Adequate Anticoagulant Control
Taylor and Ebrahim
Arch Intern Med 2001;161:1558-1558.
FULL TEXT  

A nurse led clinic and computer decision support system for anticoagulation decisions was at least as effective as a hospital clinic
Wright
Evid. Based Nurs. 2001;4:57-57.
FULL TEXT  

A nurse led clinic and computer decision support software for anticoagulation decisions were as effective as a hospital clinic
Schmitt
Evid. Based Med. 2001;6:61-61.
FULL TEXT