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

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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)?


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


9 of 21 potential general practices in Birmingham, UK.


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


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 …

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  • Sources of funding: UK Medical Research Council Reaching Our Potential Award scheme; UK National Health Service Research and Development Primary and Secondary Care Interface Programme.

  • For correspondence: Dr D A Fitzmaurice, Department of General Practice, Medical School, University of Birmingham, Birmingham B15 2TT, UK. Fax +44 (0)121 414 3759.

  • A modified version of this abstract appears in Evidence-Based Medicine.

  • * Information provided by author.