PORTALS: design of an innovative approach to anticoagulation management through eHealth

Abstract

BackgroundFor the monitoring of International Normalized Ratio (INR) values, venous thromboembolism (VTE) and atrial fibrillation (AF) patients can visit anticoagulation clinics, laboratories, or physicians for venous puncture. Point-of-care testing (POCT) made it possible for patients to monitor INR themselves (self-monitoring) and even self-adjust their medication dosage (self-dosage). Both skills are accepted as forms of self-management. eHealth applications can improve this self-management, resulting in better clinical outcomes.MethodsOur study, called PORTALS, aims at identifying the optimal implementation strategy of training to improve self-management and explore factors that enhance good self-management skills. In addition, the relationship between the implementation strategy of training, clinical outcomes, and individual characteristics will be investigated. Of the 247 recruited participants, 110 chose to continue with regular care. 137 patients have been randomly divided in subgroups and compared using a parallel cohort design: one group will be trained and educated by e-learning, and the other group will receive face-to-face group training.DiscussionMore insight in factors that enhance good self-management will help to improve clinical outcomes and patient satisfaction on anticoagulation therapy. Our study will provide practical insights and knowledge of eHealth in daily practice and of the importance of education on the adoption of self-management. We expect the self-management program including training to help patients to better manage their own INR values and medication use, thereby increasing health status and diminishing thromboembolic events and hospitalisation.Trial registrationThe Netherlands National Trial Register, number NTR3947.

A retrospective analysis of discordances between international normalized ratio (INR) self‐testing and INR laboratory testing in a pediatric patient population

“…Hence, the origin of the thromboplastin must be considered when studying INR deviations. This finding emphasize the need to develop specific quality control procedures for POC INR devices and thus make the INR self‐testing more reliable 13,28,29 …”

“…Some countries have organized a comparison on the measurement carried out regularly in a short interval of time by the patient and a healthcare professional. 28,29 The French health authorities require a six-month laboratory INR test with a concomitant home measurement. However, a discrepancy between the two INR values is not necessarily related to failure of POC device.…”

“…There are external quality control programs for POC INR used by the professional users 13,14,27 but to date no similar program using lyophilized quality control exists for the POC used at home. Some countries have organized a comparison on the measurement carried out regularly in a short interval of time by the patient and a healthcare professional 28,29 . The French health authorities require a six‐month laboratory INR test with a concomitant home measurement.…”

“…This finding emphasize the need to develop specific quality control procedures for POC INR devices and thus make the INR self-testing more reliable. 13,28,29…”

Effect of a combined education and eHealth programme on the control of oral anticoagulation patients (PORTALS study): a parallel cohort design in Dutch primary care

“…Using this design, we aimed to examine the influence of the training strategy on clinical outcomes and usage of the supporting eHealth platform. Full methodological details are reported elsewhere 29 ; Table 1 presents an overview of the study design.…”