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Evid Based Nurs 4:57 doi:10.1136/ebn.4.2.57
  • Quality improvement

A nurse led clinic and computer decision support system for anticoagulation decisions was at least as effective as a hospital clinic


 
 QUESTION: For patients who require oral anticoagulation, is a nurse led clinic that uses onsite blood testing and a computerised decision support system as effective as routine hospital care for maintaining appropriate international normalised ratios (INRs)?

Design

Randomised {allocation concealed}*, unblinded, controlled trial with 1 year of follow up.

Setting

9 of 21 potential general practices in Birmingham, UK.

Patients

224 adults (55% men) who were receiving warfarin. Follow up was 82%.

Intervention

122 patients were allocated to nurse led care in the general practice. The nurse met with the patient, measured the INR with onsite equipment, and used the computer program (Anticoagulation Management Support System [Softop Information Systems, Warwick, UK]) to direct dosing decisions. The program was based on the British Society of Haematology guidelines and had 2 main ranges of INR (2.0–3.0 and 3.0–4.5). If a dosing change was suggested, the nurse checked the change …

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