Generalizability and Adoption of Self-monitoring in Typical U.S. Health Care Settings
Despite favorable results and enhanced patient convenience, the adoption of self-monitoring (PST or PSM) into clinical practice in the United States has been fairly limited. It is estimated that of the 4 million patients receiving warfarin in the United States, only about 60,000 (1.5%) currently perform self-testing. Table 4 summarizes barriers to implementation of self-monitoring. Whether the results of most PST and PSM trials can be generalized and applied to the typical U.S. health care system remains to be determined. Most trials have been non-U.S. based, generally conducted in European countries with a more homogenous population, racial mix, and sociodemographic characteristics. In the United States, implementation of self-monitoring has been mainly reported in highly selected and stringently screened patient groups, mainly from sociodemographically select backgrounds.[35,67] One study reported use in a more heterogenous elderly population; however, feasibility data in sociodemographically disadvantaged patients and minorities are lacking. The largest U.S. study, THINRS, examined a homogenous veterans population with over 90% of enrolled subjects being Caucasian, 90% with an education level of higher than 12th grade, and 60% college educated. These characteristics are not necessarily generalizable to the long-term anticoagulated population in a typical U.S. health care setting. As minority and disadvantaged populations are at highest risk of complications and yet are the ones with the most barriers to quality care in anticoagulation clinics, it is suggested that these patients would benefit most from self-monitoring of their anticoagulation. Therefore, studies are needed to explore factors that influence the adoption of self-monitoring in the United States and to evaluate the feasibility and implementation in real-life clinical settings.
Pharmacotherapy. 2011;31(12):1161-1174. © 2011 Pharmacotherapy Publications