Fitzmaurice D A, Hobbs F D, Murray E T
Department of General Practice, The Medical School, University of Birmingham, Edgbaston.
Fam Pract. 1998 Apr;15(2):144-6. doi: 10.1093/fampra/15.2.144.
Increasing indications for warfarin therapy has led to increased pressure on primary care to undertake therapeutic monitoring.
This study evaluates a primary care model of oral anticoagulation 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 a formal study.
A prospective evaluation of therapeutic and clinical control of all patients taking warfarin within one inner city general practice. Data were collected via CDSS.
29 patients were seen in 208 appointments. The mean percentage of patients within therapeutic range was 72%. The costs to the practice were pound sterling 1751. The costs the practice would have incurred had these patients been seen at the hospital with the same frequency would have been pound sterling 2290.
The use of CDSS and NPT for nurse-delivered oral anticoagulation monitoring could enable the safe transfer of the majority of patients from secondary to primary care. Funding mechanisms to support the transfer of costs will be essential for most practices, as will be the maintenance of adequate staff training and quality assurance.
华法林治疗的适应证不断增加，给基层医疗进行治疗监测带来了更大压力。
本研究评估了一种基层医疗口服抗凝监测模式，该模式在执业护士主导的诊所内利用计算机化决策支持（CDSS）和床旁检测（NPT）。虽然这已在试验条件下被证明是一种成功的模式，但本文报告了来自长期诊所而非正式研究的首批数据。
对市中心一家全科诊所内所有服用华法林的患者进行治疗和临床控制的前瞻性评估。数据通过CDSS收集。
在208次预约中诊治了29名患者。处于治疗范围内的患者平均百分比为72%。该诊所的成本为1751英镑。如果这些患者以相同频率在医院就诊，该诊所将产生的成本为2290英镑。
使用CDSS和NPT进行护士主导的口服抗凝监测可使大多数患者安全地从二级医疗转至基层医疗。对大多数诊所来说，支持成本转移的资金机制至关重要，维持足够的员工培训和质量保证也同样重要。
