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SMART: self-management of anticoagulation, a randomised trial [ISRCTN19313375]

Record type: Article

Background Oral anticoagulation monitoring has traditionally taken place in secondary care because of the need for a laboratory blood test, the international normalised ratio (INR). The development of reliable near patient testing (NPT) systems for INR estimation has facilitated devolution of testing to primary care. Patient self-management is a logical progression from the primary care model. This study will be the first to randomise non-selected patients in primary care, to either self-management or standard care.
Method The study was a multi-centred randomised controlled trial with patients from 49 general practices recruited. Those suitable for inclusion were aged 18 or over, with a long term indication for oral anticoagulation, who had taken warfarin for at least six months. Patients randomised to the intervention arm attended at least two training sessions which were practice-based, 1 week apart. Each patient was assessed on their capability to undertake self management. If considered capable, they were given a near patient INR testing monitor, test strips and quality control material for home testing. Patients managed their own anticoagulation for a period of 12 months and performed their INR test every 2 weeks. Control patients continued with their pre-study care either attending hospital or practice based anticoagulant clinics.
Discussion The methodology used in this trial will overcome concerns from previous trials of selection bias and relevance to the UK health service. The study will give a clearer understanding of the benefits of self-management in terms of clinical and cost effectiveness and patient preference.

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Citation

McCahon, Debroah, Fitzmaurice, David A., Murray, Ellen T., Fuller, Christopher J., Hobbs, Richard F.D., Allan, Teresa F. and Raftery, James P. (2003) SMART: self-management of anticoagulation, a randomised trial [ISRCTN19313375] BMC Family Practice, 4, (11), [7pp]. (doi:10.1186/1471-2296-4-11).

More information

Published date: 18 September 2003

Identifiers

Local EPrints ID: 24420
URI: http://eprints.soton.ac.uk/id/eprint/24420
ISSN: 1471-2296
PURE UUID: 5717f105-3481-4637-ad6d-0d2b6b2ab3e2

Catalogue record

Date deposited: 30 Mar 2006
Last modified: 17 Jul 2017 16:13

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Contributors

Author: Debroah McCahon
Author: David A. Fitzmaurice
Author: Ellen T. Murray
Author: Christopher J. Fuller
Author: Richard F.D. Hobbs
Author: Teresa F. Allan

University divisions


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