Home Management of Warfarin Treatment Through a Real-Time Supervised Telemedicine Solution

A Randomized Controlled Trial

Claus L Brasen*, Jonna S Madsen, Tina Parkner, Ivan Brandslund

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Many patients are undergoing oral anticoagulation treatment with vitamin K antagonists, which necessitates measuring international normalized ratio (INR) several times each month.

INTRODUCTION: Patients can learn to measure their INR at home and choose their own dose for the next period with potential gains in treatment quality and reduced healthcare expenses. This is, however, connected to the potential problem of losing tight external control of the patient treatment.

MATERIALS AND METHODS: We performed a randomized controlled trial using the telemedicine software CSO/AC together with the INR point-of-care-test CoaguChek XS for 10 months to investigate the use of criteria-driven healthcare interactions. A total of 87 patients were divided into two groups. The patient self-management (PSM) group was surveilled using the criteria INR <1.8, INR >4.5, change in warfarin/week >1.25 mg, missing INR or dosage. The patient self-testing (PST) group was handled as routine care.

RESULTS: A total of 84 patients were followed for 10 months. No differences were seen in average INR or fraction of INR in therapeutic range (2-3) in the two groups or the start compared with the end. The PST group was handled using 4.2 interactions per month whereas the PSM group used 1.1 interactions per month. No adverse effects of PSM were observed.

DISCUSSION: Using criteria-driven interactions enabled a considerable reduction in interactions per month. The two groups were comparable in terms of treatment effect and safety.

CONCLUSIONS: Using criteria to guide PSM interactions maintains good treatment effect while reducing healthcare expenses.

Original languageEnglish
JournalTelemedicine and e-Health
Volume25
Issue number2
Pages (from-to)109-115
ISSN1530-5627
DOIs
Publication statusPublished - Feb 2019

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Warfarin
Randomized Controlled Trials
International Normalized Ratio
Point-of-Care Systems
Delivery of Health Care
Quality of Health Care
Safety

Keywords

  • Coaguchek XS
  • INR
  • POCT
  • home management
  • randomized controlled trial
  • telemedicine
  • warfarin

Cite this

@article{7daaae57f8ec4a00bfd079b047d742b1,
title = "Home Management of Warfarin Treatment Through a Real-Time Supervised Telemedicine Solution: A Randomized Controlled Trial",
abstract = "BACKGROUND: Many patients are undergoing oral anticoagulation treatment with vitamin K antagonists, which necessitates measuring international normalized ratio (INR) several times each month.INTRODUCTION: Patients can learn to measure their INR at home and choose their own dose for the next period with potential gains in treatment quality and reduced healthcare expenses. This is, however, connected to the potential problem of losing tight external control of the patient treatment.MATERIALS AND METHODS: We performed a randomized controlled trial using the telemedicine software CSO/AC together with the INR point-of-care-test CoaguChek XS for 10 months to investigate the use of criteria-driven healthcare interactions. A total of 87 patients were divided into two groups. The patient self-management (PSM) group was surveilled using the criteria INR <1.8, INR >4.5, change in warfarin/week >1.25 mg, missing INR or dosage. The patient self-testing (PST) group was handled as routine care.RESULTS: A total of 84 patients were followed for 10 months. No differences were seen in average INR or fraction of INR in therapeutic range (2-3) in the two groups or the start compared with the end. The PST group was handled using 4.2 interactions per month whereas the PSM group used 1.1 interactions per month. No adverse effects of PSM were observed.DISCUSSION: Using criteria-driven interactions enabled a considerable reduction in interactions per month. The two groups were comparable in terms of treatment effect and safety.CONCLUSIONS: Using criteria to guide PSM interactions maintains good treatment effect while reducing healthcare expenses.",
keywords = "Coaguchek XS, INR, POCT, home management, randomized controlled trial, telemedicine, warfarin",
author = "Brasen, {Claus L} and Madsen, {Jonna S} and Tina Parkner and Ivan Brandslund",
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Home Management of Warfarin Treatment Through a Real-Time Supervised Telemedicine Solution : A Randomized Controlled Trial. / Brasen, Claus L; Madsen, Jonna S; Parkner, Tina; Brandslund, Ivan.

In: Telemedicine and e-Health, Vol. 25, No. 2, 02.2019, p. 109-115.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Home Management of Warfarin Treatment Through a Real-Time Supervised Telemedicine Solution

T2 - A Randomized Controlled Trial

AU - Brasen, Claus L

AU - Madsen, Jonna S

AU - Parkner, Tina

AU - Brandslund, Ivan

PY - 2019/2

Y1 - 2019/2

N2 - BACKGROUND: Many patients are undergoing oral anticoagulation treatment with vitamin K antagonists, which necessitates measuring international normalized ratio (INR) several times each month.INTRODUCTION: Patients can learn to measure their INR at home and choose their own dose for the next period with potential gains in treatment quality and reduced healthcare expenses. This is, however, connected to the potential problem of losing tight external control of the patient treatment.MATERIALS AND METHODS: We performed a randomized controlled trial using the telemedicine software CSO/AC together with the INR point-of-care-test CoaguChek XS for 10 months to investigate the use of criteria-driven healthcare interactions. A total of 87 patients were divided into two groups. The patient self-management (PSM) group was surveilled using the criteria INR <1.8, INR >4.5, change in warfarin/week >1.25 mg, missing INR or dosage. The patient self-testing (PST) group was handled as routine care.RESULTS: A total of 84 patients were followed for 10 months. No differences were seen in average INR or fraction of INR in therapeutic range (2-3) in the two groups or the start compared with the end. The PST group was handled using 4.2 interactions per month whereas the PSM group used 1.1 interactions per month. No adverse effects of PSM were observed.DISCUSSION: Using criteria-driven interactions enabled a considerable reduction in interactions per month. The two groups were comparable in terms of treatment effect and safety.CONCLUSIONS: Using criteria to guide PSM interactions maintains good treatment effect while reducing healthcare expenses.

AB - BACKGROUND: Many patients are undergoing oral anticoagulation treatment with vitamin K antagonists, which necessitates measuring international normalized ratio (INR) several times each month.INTRODUCTION: Patients can learn to measure their INR at home and choose their own dose for the next period with potential gains in treatment quality and reduced healthcare expenses. This is, however, connected to the potential problem of losing tight external control of the patient treatment.MATERIALS AND METHODS: We performed a randomized controlled trial using the telemedicine software CSO/AC together with the INR point-of-care-test CoaguChek XS for 10 months to investigate the use of criteria-driven healthcare interactions. A total of 87 patients were divided into two groups. The patient self-management (PSM) group was surveilled using the criteria INR <1.8, INR >4.5, change in warfarin/week >1.25 mg, missing INR or dosage. The patient self-testing (PST) group was handled as routine care.RESULTS: A total of 84 patients were followed for 10 months. No differences were seen in average INR or fraction of INR in therapeutic range (2-3) in the two groups or the start compared with the end. The PST group was handled using 4.2 interactions per month whereas the PSM group used 1.1 interactions per month. No adverse effects of PSM were observed.DISCUSSION: Using criteria-driven interactions enabled a considerable reduction in interactions per month. The two groups were comparable in terms of treatment effect and safety.CONCLUSIONS: Using criteria to guide PSM interactions maintains good treatment effect while reducing healthcare expenses.

KW - Coaguchek XS

KW - INR

KW - POCT

KW - home management

KW - randomized controlled trial

KW - telemedicine

KW - warfarin

U2 - 10.1089/tmj.2017.0260

DO - 10.1089/tmj.2017.0260

M3 - Journal article

VL - 25

SP - 109

EP - 115

JO - Telemedicine and e-Health

JF - Telemedicine and e-Health

SN - 1530-5627

IS - 2

ER -