In considering the practise of family medicine in Canada, two facts regarding anticoagulation control are apparent: (a) family physicians shoulder the majority of the treatment responsibility; and (b) control is likely not optimal. PSM in RCT's have shown to improve therapeutic control in patients when compared to "usual care"5,7 and also to care from anticoagulation clinics in tertiary care hospitals. This improved control has shown to be associated with improved clinically relevant endpoints. Thus, it would be logical to suggest that implementing PSM strategies in Canadian primary care settings would have the greatest return. There are several problems with this logic though. Firstly, RCT's all involved extensive training sessions with nurse clinicians or specialized physicians at tertiary care centres to educate participants in the fundamentals of warfarin therapy and the adjustment regimes. These resources are simply not available for family physicians. Secondly, "point of care" electronic INR testing devices were provided to all patients, which would cost an average patient approximately $1000 with the added cost of testing strips.