University of Alberta, Edmonton, AB.
Can Fam Physician. 2012 Aug;58(8):e465-71.
To determine whether community-based, nurse-led monitoring of the international normalized ratio (INR) in patients requiring long-term warfarin therapy was comparable to traditional physician monitoring.
A retrospective cohort analysis of patients taking long-term warfarin therapy.
The study used data gathered from 3 family medicine clinics in a primary care network in Edmonton, Alta.
Medical records of patients currently taking warfarin were examined.
Implementation of nurse-led monitoring in a primary care network in place of standard family physician INR monitoring.
The degree of INR control before and after the implementation of nurse-run INR monitoring was assessed. The average proportion of time spent outside of therapeutic INR ranges, as well as the average number of days between successive INR readings, was calculated and compared. The degree of control placed patients into either a good-control group (out of range ≤ 25% of the time) or a moderate-control group (out of range > 25% of the time) and these groups were compared.
Before nurse monitoring, INR values were out of range 20.4% of the time; after nurse monitoring they were out of range 19.2% of the time (P = .115); the time between sequential INR readings also did not differ before and after implementation of nurse monitoring (23.9 vs 21.6 days, P = .789).
Nurse-led monitoring of INR is as effective as traditional physician monitoring. Advantages of nurse-led monitoring might include freeing family physicians to see more patients or to spend less time at work. It might also represent potential cost savings.
确定以社区为基础、由护士主导的国际标准化比值（INR）监测是否与传统的医生监测相当，适用于需要长期华法林治疗的患者。
对接受长期华法林治疗的患者进行回顾性队列分析。
该研究使用了艾伯塔省埃德蒙顿一个初级保健网络中的 3 家家庭医学诊所收集的数据。
检查目前正在服用华法林的患者的病历。
在初级保健网络中实施护士主导的 INR 监测，替代标准家庭医生 INR 监测。
评估实施护士管理 INR 监测前后 INR 控制程度。计算并比较平均 INR 超出治疗范围的时间比例以及两次连续 INR 读数之间的平均天数。根据控制程度将患者分为良好控制组（INR 超出范围时间≤25%）或中度控制组（INR 超出范围时间>25%），并对这些组进行比较。
在护士监测之前，INR 值超出范围的时间为 20.4%；在护士监测之后，INR 值超出范围的时间为 19.2%（P =.115）；实施护士监测前后两次连续 INR 读数之间的时间间隔也没有差异（23.9 天与 21.6 天，P =.789）。
护士主导的 INR 监测与传统的医生监测同样有效。护士主导的监测的优势可能包括使家庭医生能够看更多的患者或减少工作时间。它还可能代表潜在的成本节约。
