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Letter to the Editor

Editor, – We read Associate Professor Shephard's article with interest (Aust Prescr 2010;33:6–9), and wish to highlight emerging uses for point-of-care INR monitors in Australia. These have been trialled in various settings including:

  • rural general practices1and community pharmacies2, to improve warfarin safety in patients with limited access to pathology services
  • patients' homes, to facilitate self-monitoring via a standardised training program3*and as a part of a multi-faceted post-discharge service provided by home medicines review accredited pharmacists4*
  • within residential care facilities.5

These projects, conducted by the Unit for Medication Outcomes Research and Education (UMORE), have improved patient outcomes and produced excellent stakeholder satisfaction. For example, the post-discharge service was recently associated with reduced rates of warfarin-related adverse events up to 90 days post-discharge.4

Patient self-monitoring is well established in Europe, where it is associated with improved anticoagulation control, enhanced patient convenience and adherence, fewer complications and improved survival in suitable patients.6Currently, only a small proportion of Australian patients taking warfarin perform self-monitoring, a situation that could be improved by a national training, quality assurance and support program.

We believe that appropriate use of point-of-care INR monitors outside traditional settings can potentially improve patients' quality of life and health outcomes and, as such, should be actively promoted and government-funded.

Gregory Peterson, Leanne Stafford, Luke Bereznicki, Ella van Tienen and Shane Jackson

Unit for Medication Outcomes Research and Education
(UMORE), School of Pharmacy
University of Tasmania

*These programs were funded by the Department of Health and Ageing as part of the Fourth Community Pharmacy Agreement managed by the Pharmacy Guild of Australia


  1. Marsden KA, Jupe DM, Vial JH. Accuracy and clinical usefulness of the near-patient testing CoaguChek S international normalised ratio monitor in rural medical practice. Aust J Jackson SL, Bereznicki LR, Peterson GM, Marsden KA, Jupe DM, Vial JH, et al. Accuracy and clinical usefulness of the near-patient testing CoaguChek S international normalised ratio monitor in rural medical practice. Aust J Rural Health 2004;12:137-42.
  2. Jackson SL, Peterson GM, House M, Bartlett T. Point-of-care monitoring of anticoagulant therapy by rural community pharmacists: description of successful outcomes. Aust J Rural Health 2004;12:197-200.
  3. Jeffrey EC, Bereznicki LR, Stafford L, Peterson GM. Evaluation of a clinical pathway to enable patient self-monitoring of anticoagulation. In: HAA Handbook and Final Programme. Adelaide: 2009. p. 276.
  4. Peterson GM, Stafford L, Bereznicki LR, van Tienen EC, Jackson SL, on behalf of the Project Team. The role of community pharmacy in post hospital management of patients initiated on warfarin. In: Pharmacy Practice Research Summit Program. Canberra: 2010. p. 14.
  5. Peterson G, Jackson S, Gee P, Bereznicki L, Bereznicki B, Fitzmaurice K, et al. Improving the management of warfarin in aged care facilities utilising an innovative IT solution. In: Australasian Pharmaceutical Science Association Conference. 2007. Manly.
  6. Garcia-Alamino JM, Ward AM, Alonso-Coello P, Perera R, Bankhead C, Fitzmaurice D, et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Database Syst Rev 2010;4(Art. No.: CD003839).