Using an electronic medical record patient portal for warfarin self-management: Empowering children and parents

Jones, Sophie; Hislop, J.L.; Gilmore, H. William; Greenway, Anthea; Hibbard, James; Monagle, Paul; Newall, Fiona

doi:10.1016/j.rpth.2023.100066

Cited by 7 publications

(24 citation statements)

References 31 publications

(53 reference statements)

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“…Although this study by Jones et al. [ 3 ] largely replicates the findings from other studies of adult patients using warfarin PSM, there are important questions about how to disseminate this care model broadly ( Table ). First, awareness by both patients and clinicians is a key step.…”

supporting

confidence: 61%

“…This observational study by Jones et al. [ 3 ] quantitatively and qualitatively evaluated the use of an EHR communication tool to facilitate warfarin patient self-management (PSM) in a pediatric cohort. Participants under the age of 18 years were eligible based on prior use and adherence to home INR self-testing, a minimum of 6 months prior treatment with warfarin, and a planned duration of treatment for at least 12 months.…”

mentioning

confidence: 99%

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When technology improves patient care and provider experience

Barnes¹,

Weyand²

2023

Research and Practice in Thrombosis and Haemostasis

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supporting

confidence: 61%

mentioning

confidence: 99%

When technology improves patient care and provider experience

Barnes¹,

Weyand²

2023

Research and Practice in Thrombosis and Haemostasis

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“…One focus group participant summarized this sentiment in the following quote, “[PSM] is probably easier than what many Type 1 diabetics do. Kids learn how to use an insulin pump and test glucose very young.” Given the comfort of having patients, in particular young children, self‐managing insulin doses, it may be reasonable to explore the use of warfarin PSM in varying age groups 21 …”

Section: Discussionmentioning

confidence: 99%

“…European and US patients. 21 Most providers believed that a home INR monitor would be critical to successful PSM implementation. Unfortunately, only a small proportion of US patients have access to these point-of-care devices.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study evaluating provider perceptions of implementing warfarin patient self‐management in the United States healthcare system

Wilson,

Slager,

Jones

et al. 2023

J Am Coll Clin Pharm

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BackgroundDespite consensus guideline recommendations, the use of warfarin patient self‐management (PSM) in the US healthcare system remains small in comparison to European countries.ObjectivesTo gain understanding of the barriers and facilitators to warfarin PSM in US healthcare systems through exploration of the opinions of select US anticoagulation management service providers.MethodsFocus group discussions were conducted at five geographically diverse sites. Grounded theory analysis was performed on focus group transcriptions using the consolidated framework for implementation research (CFIR) to identify facilitators and barriers to PSM implementation within the US healthcare system.ResultsA total of 29 providers participated in eight focus group sessions. Five major themes emerged from the interviews: (1) “Ideal” PSM candidates possess identifiable characteristics (CFIR domain “Characteristics of Individuals”); (2) Providers harbor fears and lack familiarity with PSM facts and principles (CFIR domains “Characteristics of Individuals”; “Inner Setting”; and “Outer Setting”); (3) Providers mistrust patients' capability to engage in PSM (CFIR domains “Characteristics of Individuals”; “Inner Setting”; “Outer Setting”; and “Process”); (4) Despite acknowledging PSM advantages many providers cite workflow issues as barriers to implementation (CFIR domains “Intervention Characteristics”; “Inner Setting”; “Outer Setting”; and “Process”); and (5) Providers differed on how to best train patients to do PSM (CFIR domains “Intervention Characteristics”; and “Inner Setting”).ConclusionsProvider concern for patient safety contributes to hesitancy to relinquish control and mistrust of patients' ability to participate in PSM. Education and implementation strategies will be key to overcoming barriers to PSM in the United States.

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“…A recent review suggests that patient education about anticoagulation through a mobile device, such as a smartphone or tablet, increases patient knowledge levels, medication adherence, and satisfaction and is associated with improved clinical outcomes [ 14 ]. EHR-based programs have also been identified as a valuable method to improve warfarin therapy, a type of anticoagulation, self-management for pediatric patients with congenital heart diseases [ 15 ]. Evaluating patient responsiveness to different portal-based messaging methods can help identify the optimal use of EHR patient portal tools to best support patients in managing their AF and anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study

Kapoor,

Patel,

Chennupati

et al. 2024

JMIR Cardio

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Background The gap in anticoagulation use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal–based messaging linked to educational materials may help bridge this gap, but the most effective messaging approach is unknown. Objective This study aims to compare the responsiveness of patients with AF to an AF or anticoagulation educational message between 2 portal messaging approaches: sending messages targeted at patients with upcoming outpatient appointments 1 week before their scheduled appointment (targeted) versus sending messages to all eligible patients in 1 blast, regardless of appointment scheduling status (blast), at 2 different health systems: the University of Massachusetts Chan Medical School (UMass) and the University of Florida College of Medicine-Jacksonville (UFL). Methods Using the 2 approaches, we sent patient portal messages to patients with AF and grouped patients by high-risk patients on anticoagulation (group 1), high-risk patients off anticoagulation (group 2), and low-risk patients who may become eligible for anticoagulation in the future (group 3). Risk was classified based on the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age between 65 and 74 years, and sex category (CHA2DS2-VASc) score. The messages contained a link to the Upbeat website of the Heart Rhythm Society, which displays print and video materials about AF and anticoagulation. We then tracked message opening, review of the website, anticoagulation use, and administered patient surveys across messaging approaches and sites using Epic Systems (Epic Systems Corporation) electronic health record data and Google website traffic analytics. We then conducted chi-square tests to compare potential differences in the proportion of patients opening messages and other evaluation metrics, adjusting for potential confounders. All statistical analyses were performed in SAS (version 9.4; SAS Institute). Results We sent 1686 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on anticoagulation (723/1156, 62.5% vs 382/668, 57.2%; P=.005) and trended the same in patients off anticoagulation; subsequent website reviews did not differ by messaging approach. More patients off anticoagulation at baseline started anticoagulation with the targeted approach than the blast approach (adjusted percentage 9.3% vs 2.1%; P<.001). Conclusions Patients were more responsive in terms of message opening and subsequent anticoagulation initiation with the targeted approach.

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Using an electronic medical record patient portal for warfarin self-management: Empowering children and parents

Cited by 7 publications

References 31 publications

When technology improves patient care and provider experience

When technology improves patient care and provider experience

A qualitative study evaluating provider perceptions of implementing warfarin patient self‐management in the United States healthcare system

Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study

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