Does the Birmingham model of oral anticoagulation management in primary care work outside trial conditions?

The effectiveness of the Birmingham model of primary care oral anticoagulat ion management has previously been demonstrated within a randomised control led trial. The aim of this study was to assess the effectiveness of the Bir mingham model in routine care All patients from 12 primary care centres att ending either practice-based or hospital-based and coagulation ch. m I cs w ere retrospectively followed up from October 1996 to March 1998. Outcome me asures were therapeutic international Normalised Ratio (INR) control, haemo rrhagic and thrombotic episodes, and recall frequency,, 452 patients who ha d two or more INR results during the follow-up period were investigated. Th ere were no significant differences between practice-based and hospital-bas ed populations in terms of the percentage time in range, (69 % and 64% resp ectively). The proportion of tests in range was significantly higher in the practice-based group (61 % practice-based, 57% hospital-based; P = 0.015). There was no difference between the two populations in terms of mean follo w-up time (36 days in each group). There were no significant differences be tween groups for the number of clinical outcomes per patient. This study co nfirmed that, within these practices, oral anticoagulation management is sa fe and effective using the Birmingham model.