Direct-to-patient expert system and home INR monitoring improves control of oral anticoagulation

O’Shea, Susan; Arcasoy, Murat O.; Samsa, Gregory P.; Cummings, Sandra E.; Thames, Elizabeth; Ortel, Thomas L.

doi:10.1007/s11239-007-0068-y

Cited by 33 publications

(32 citation statements)

References 37 publications

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“…Our results are consistent with the improvements in TTR associated with PST and online systems in three other studies [17,37,38]. The studies by O’Shea et al [17] and Ryan et al [37] used the same Internet-based system, which provided a decision-support tool to assist patients adjust their own warfarin dose.…”

Section: Discussionsupporting

confidence: 90%

“…The literature suggests that patients in the community spend 50-60% of their time within the target range [16]. It was envisaged that this could be improved to 75% with the intervention based on a prior study involving a similar intervention [17]. At a power of 80% and statistical significance set at 0.05, 16 patients analyzed before and after were required.…”

Section: Methodsmentioning

confidence: 99%

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Supervised Patient Self-Testing of Warfarin Therapy Using an Online System

Bereznicki¹,

Jackson²,

Peterson³

2013

J Med Internet Res

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BackgroundPoint-of-care international normalized ratio (INR) monitoring devices simplify warfarin management by allowing selected patients to monitor their own therapy in their homes. Patient self-testing (PST) has been shown to improve the clinical outcomes of warfarin therapy compared to usual care.ObjectiveTo compare management of warfarin therapy using PST combined with online supervision by physicians via a custom system with usual warfarin management, which involved laboratory testing and physician dosing.MethodsInterested patients were recruited via community pharmacies to participate in a warfarin PST training program. Participants were required to have a long-term indication for warfarin, have been taking warfarin for at least 6 months, and have Internet access in their home. The training involved two sessions covering theoretical aspects of warfarin therapy, use of the CoaguChek XS, and the study website. Following training, patients monitored their INR once weekly for up to 3 months. Patients and physicians utilized a secure website to communicate INR values, dosage recommendations, and clinical incidents. Physicians provided a 6-12 month history of INR results for comparison with study results. The percentage of time spent within the therapeutic INR range (TTR) was the primary outcome, with participants acting as their own historical controls. The percentage of INR tests in range and participant satisfaction were secondary outcomes.ResultsSixteen patients completed training requirements. The mean age of participants was 69.8 (SD 10.1) years. TTR improved significantly from 66.4% to 78.4% during PST (P=.01), and the number of tests within the target range also improved significantly (from 66.0% at prior to the study to 75.9% during PST; P=.04). Patients and physicians expressed a high degree of satisfaction with the monitoring strategy and online system.ConclusionsPST supported by an online system for supervision was associated with improved INR control compared to usual care in a small group of elderly patients. Further research is warranted to investigate the clinical outcomes and cost-effectiveness of online systems to support patients monitoring medications and chronic conditions in the home.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Supervised Patient Self-Testing of Warfarin Therapy Using an Online System

Bereznicki¹,

Jackson²,

Peterson³

2013

J Med Internet Res

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“…If good anticoagulation control cannot be achieved within the usual care setting, specialized anticoagulation management such as anticoagulation clinics or handheld patient INR meters are validated alternative options [5,25]. Finally, substitution with newer oral anticoagulants is inevitable in patients with NVAF.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the impact of warfarin time in therapeutic range on outcomes of patients with atrial fibrillation in Turkey: Perspectives from the observational, prospective WATER Registry

et al. 2015

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Background: Warfarin is highly efficacious in reducing stroke risk in patients with atrial fibrillation (AF). However, its safety and efficacy in stroke prevention is markedly influenced by its time in therapeutic range (TTR (40.3 ± 18 vs. 46.9 ± 19, respectively, p < 0.001). Death, cardiac hospitalization and minor bleeding rates were higher in the group with TTR value < 40% than the group with > 40% (3.4% vs. 5.9%; 28.6% vs. 35.4%; 36.5% vs. 41.7%, respectively, all of them p < 0.001). A correlation analysis showed a negative correlation between age and TTR value (r = -0.178, p < 0.001 non-valvular AF patients. (Cardiol J 2015; 22, 5: 567-575)

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“…For those undertaking self-testing, specific details of the arrangements for adjustment of dosage were not captured. Several studies have however shown improvements in therapeutic control in patients that self-test and have direct access to an internet-based decision support system or clinical supervisor for dosing advice 19 21 22. In a prospective, single-group, before and after study, O’ Shea et al demonstrated an increase in therapeutic time in range from 63% in the anticoagulation clinic to 74% during internet supervision 21.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have however shown improvements in therapeutic control in patients that self-test and have direct access to an internet-based decision support system or clinical supervisor for dosing advice 19 21 22. In a prospective, single-group, before and after study, O’ Shea et al demonstrated an increase in therapeutic time in range from 63% in the anticoagulation clinic to 74% during internet supervision 21. Similarly, a subsequent randomised, cross-over study, using the same internet-based system, reported an improvement in therapeutic control from 59% to 74% 19.…”

Section: Discussionmentioning

confidence: 99%