Primary care anticoagulant clinic management using computerized decision support and near patient International Normalized Ratio (INR) testing: routine data from a practice nurse-led clinic

BACKGROUND: Increasing indications for warfarin therapy has led toincreased pressure on primary care to undertake therapeutic monitoring.OBJECTIVE: This study evaluates a primary care model of oralanticoagulation monitoring which utilises computerized decision support(CDSS) and near patient testing (NPT) within a practice nurse-led clinic.Whilst this has been shown to be a successful model under trial conditions,this paper reports the first data from a long-standing clinic, outside aformal study. METHOD: A prospective evaluation of therapeutic and clinicalcontrol of all patients taking warfarin within one inner city generalpractice. Data were collected via CDSS. RESULTS: 29 patients were seen in208 appointments. The mean percentage of patients within therapeutic rangewas 72%. The costs to the practice were pound sterling 1751. The costs thepractice would have incurred had these patients been seen at the hospitalwith the same frequency would have been pound sterling 2290. CONCLUSIONS:The use of CDSS and NPT for nurse-delivered oral anticoagulation monitoringcould enable the safe transfer of the majority of patients from secondaryto primary care. Funding mechanisms to support the transfer of costs willbe essential for most practices, as will be the maintenance of adequatestaff training and quality assurance.