Primary care anticoagulant management using near patient testing

Background. Indications for anticoagulant treatment are increasing and new approaches to anticoagulant services require a shift from hospital to primary care. Aim. To pragmatically test the validity and effectiveness of primary care anticoagulant management using near patient testing. Methods. Twelve CoaguCheck monitors were supplied to 16 rural practices that had previously provided supervision of anticoagulant therapy. Practices were required to record data for eligible patients from September 1998 to April 1999 and to forward one blood sample per week to the regional hospital laboratory for parallel testing. Results. Nine practices returned data on 122 patients. Indications for anticoagulation included atrial fibrillation (n=56), valve replacement (n= 12) and deep venous thrombosis or pulmonary embolus (n= 12). Regression of the mean of 185 paired readings against their difference confirmed the validity of the CoaguCheck monitor (r² = 0.00 [95% CI -0.38 to 0.38]). There were 692 International Normalised Ratio (INR) tests performed representing an average of 5.7 tests per patient. The desired therapeutic range was provided for 609 (88%) of these tests; 294 (48.3%) were within the desired therapeutic range. Results differed significantly between practices. Conclusions. This study confirmed the validity of anticoagulant management using the CoaguCheck monitor in primary care.