GPs urge MPs to probe growing role of drug companies in primary care
Patients are capable of managing their own anticoagulation therapy, a new study suggests, brushing aside fears that self-monitoring would not be safe.
The RCGP regards monitoring anticoagulants as sufficiently tricky to merit a new guidance booklet for GPs, in response to the increasing numbers taking it on as an
But GP researchers at the University of Birmingham found that patients could safely keep their international normalised ratios within the target range.
The study's author, Professor David Fitzmaurice, said Germany was already rolling out self-management schemes to 70,000 patients, but he claimed 'perverse disincentives' in the new contract were putting the pioneering approach at risk in the UK.
The study, presented at an international conference on general practice last month in Amsterdam, randomised 617 patients to ordinary care or self-management, in which patients measured their INR using home testing devices. They interpreted results using a 'traffic light' reference sheet to guide them on whether to adjust dosage or consult a health care professional.
The study found 70 per cent of self-monitoring patients kept within the target range and 68 per cent of controls. A quarter of patients were willing to participate, with 43 per cent dropping out over the study period.
Professor Fitzmaurice, professor of primary care at the university and a GP in the city, said anticoagulation self-management was a 'logical step'
after the success of similar schemes in patients with diabetes. He said the rise in numbers of patients taking warfarin was putting increasing pressure on monitoring clinics.
'[Self-management] will free up space, but not a huge amount. It is much more about empowering patients to take control of their disease.'
He said the new contract had the effect of evening up care, so that the worst practices were pulled up, but the better and more innovative ones received less funding.
Dr Mayur Lakhani, chair-elect of the RCGP and editor of its In Safer Hands guide on warfarin, said self-management was empowering, but was only suitable for the most motivated and intelligent patients.
By Rob Finch