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


OBJECTIVE
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.


CONCLUSIONS
PSM outside trial conditions is as clinically effective as routine UK care.
McCahon
D
D
Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK.
Murray
E T
ET
Jowett
S
S
Sandhar
H S
HS
Holder
R L
RL
Hussain
S
S
O'Donoghue
B
B
Fitzmaurice
D A
DA
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D016903:Drug Monitoring / Q000191:economics / Q000379:methods / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011786:Quality Control; D012189:Retrospective Studies; D012646:Self Administration / Q000191:economics / Q000379:methods / Q000592:standards; D014859:Warfarin / Q000008:administration & dosage* / Q000191:economics
D000925:Anticoagulants; D014859:Warfarin