Anticoagulation Patient Self-monitoring in the United States

Considerations for Clinical Practice Adoption

Edith A. Nutescu, Pharm.D.; Sacheeta Bathija, B.Pharm.; Lisa K. Sharp, Ph.D.; Ben S. Gerber, M.D., M.P.H.; Glen T. Schumock, Pharm.D., M.B.A.; Marian L. Fitzgibbon, Ph.D.

Disclosures

Pharmacotherapy. 2011;31(12):1161-1174. 

In This Article

Patient Education and Competency

Patients enrolled in PST and PSM groups received more extensive training and education compared with patients assigned to standard care. Generally, patients received a structured education program and training in self-testing.[35] The education intervention was usually composed of 2–4 small group training sessions held over several weeks in 1–3-hour increments. This phase was followed by patient competency evaluation after a period of home-based practice. In addition to receiving training in conducting self-testing, most studies also provided information on anticoagulation therapy such as drug-drug and drug-food interactions, dosing by algorithm in the patients performing self-management of dosing, when to test, and who and when to call for help. A 24-hour telephone help line was available for patients to call in some studies. Some studies provided more extensive training including a behavioral education intervention coupled by training by a lay educator and a subsequent home visit within 3 days of discharge.[66] Other interventions were incorporating Web-based direct-to-patient expert systems in which patients enter their INRs and relevant clinical information and receive dosing instructions from the system.[39,69,70] Most of the studies were not designed to determine the contribution of education and other components of the intervention (i.e., self-monitoring vs education vs coaching vs expert guidance of dosing) to the study outcomes. In the two studies that evaluated the independent effect of patient education on time in therapeutic INR range, one found no effect,[50,51] and the other study found a significant effect using a before-and-after within-group comparison.[54]

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