Vadher B D, Patterson D L, Leaning M
Clinical and Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK.
Clin Lab Haematol. 1997 Sep;19(3):203-7.
With increasing work-loads in anticoagulant clinics different methods of service delivery need evaluation. The quality of anticoagulant control achieved by a nurse-practitioner using a computer decision-support system (CDSS) was compared with that achieved by trainee doctors without CDSS. Eighty-one out-patients (group A, therapeutic range 2-3) and 96 out-patients (group B, therapeutic range 3-4.5) were randomized to management by a nurse-practitioner or by trainee doctors (clinicians). Thirty-seven patients in group A and 50 patients in group B were randomized to be managed by the nurse-practitioner. In group A, patients in the nurse-practitioner group spent a longer time in the therapeutic range than those in the clinician group (60.7% compared with 51.6%). Dose suggestion acceptance in the nurse-practitioner group (88%) was higher compared with agreement between the CDSS and the clinicians (60%). In group B, patients in the clinician group spent a slightly longer time in the therapeutic range (70% compared with 67.6%). Acceptance of dose suggestion was lower in the nurse-practitioner group (67%) compared with agreement between the CDSS and the clinicians (73%). In conclusion, the CDSS can improve the quality of control of warfarin therapy by a nurse-practitioner over that by trainee doctors for the therapeutic range 2-3. Similar quality of control is achieved for the therapeutic range 3-4.5. The CDSS may be used by nurse-practitioners to achieve safe and effective anticoagulation in hospital-based or out-reach anticoagulant clinics.
随着抗凝门诊工作量的增加，需要对抗凝服务的不同提供方式进行评估。将使用计算机决策支持系统（CDSS）的执业护士实现的抗凝控制质量与未使用CDSS的实习医生实现的抗凝控制质量进行比较。81名门诊患者（A组，治疗范围2 - 3）和96名门诊患者（B组，治疗范围3 - 4.5）被随机分配给执业护士或实习医生（临床医生）进行管理。A组中的37名患者和B组中的50名患者被随机分配给执业护士管理。在A组中，执业护士组的患者在治疗范围内花费的时间比临床医生组的患者长（分别为60.7%和51.6%）。执业护士组的剂量建议接受率（88%）高于CDSS与临床医生之间的一致率（60%）。在B组中，临床医生组的患者在治疗范围内花费的时间略长（分别为70%和67.6%）。执业护士组的剂量建议接受率（67%）低于CDSS与临床医生之间的一致率（73%）。总之，对于2 - 3的治疗范围，CDSS可以提高执业护士对华法林治疗的控制质量，优于实习医生。对于3 - 4.5的治疗范围，可实现类似的控制质量。执业护士可以使用CDSS在医院或外展抗凝门诊实现安全有效的抗凝治疗。
