August 14, 2000Archives of Internal Medicine
Oral Anticoagulation Management in Primary Care With the Use of Computerized Decision Support and Near-Patient Testing
Key result
Nurse-led primary care clinics with computerized decision support and near-patient testing improved the proportion of time spent in the therapeutic INR range compared to hospital care (P=0.008).
Why the study?
Does a nurse-led primary care clinic with computerized decision support and near-patient testing improve therapeutic control of INR in patients on oral anticoagulation compared to routine hospital management?
Population
367 patients requiring oral anticoagulation monitoring across 12 primary care practices
Comparison
Nurse-led primary care anticoagulation clinic… vs Routine hospital management (hospital clinic)
Design
RCT, Randomized at both practice level and patient level within intervention…
Authors
Discussion
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Member takes
Implication
Supports shifting anticoagulation monitoring to nurse-led primary care; extends RCT evidence for computerized decision support.
Study Design
Type
RCT (n=367)
Randomization
Randomized
Multicenter
Yes
Structured PICO
Does a nurse-led primary care clinic with computerized decision support and near-patient testing improve therapeutic control of INR in patients on oral anticoagulation compared to routine hospital management?
P
Population
367 patients requiring oral anticoagulation monitoring across 12 primary care practices
I
Intervention
Nurse-led primary care anticoagulation clinic involving near-patient testing and computerized decision support software
C
Comparator
Routine hospital management (hospital clinic)
O
Outcome
Therapeutic control of the international normalized ratio (point prevalence)surrogate
Main Result
p-value: p=0.008
A nurse-led primary care anticoagulation clinic using computerized decision support and near-patient testing provides INR control at least as good as routine hospital follow-up, with significantly improved time in therapeutic range.
Cite This Study
Fitzmaurice et al. (2000) conducted an RCT in Patients requiring oral anticoagulation (n=367). Nurse-led primary care clinic with near-patient testing and computerized decision support vs. Routine hospital management was evaluated on Therapeutic control of the international normalized ratio (p=0.008). Nurse-led primary care clinics with computerized decision support and near-patient testing improved the proportion of time spent in the therapeutic INR range compared to hospital care (P=0.008).