Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system.

Hdl Handle:
http://hdl.handle.net/10147/200964
Title:
Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system.
Authors:
Ryan, F; Byrne, S; O'Shea, S
Affiliation:
Pharmaceutical Care Research Group, University College Cork, Cork, Ireland.
Citation:
Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system. 2009, 7 (8):1284-90 J. Thromb. Haemost.
Journal:
Journal of thrombosis and haemostasis : JTH
Issue Date:
Aug-2009
URI:
http://hdl.handle.net/10147/200964
DOI:
10.1111/j.1538-7836.2009.03497.x
PubMed ID:
19496921
Abstract:
Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT.; A prospective, randomized controlled cross-over study was performed to test the hypothesis that supervised PST using an internet-based, direct-to-patient expert system could provide improved anticoagulation control as compared with that provided by an anticoagulation management service (AMS). During the 6 months of supervised PST, patients measured their INR at home using a portable meter and entered this result, along with other information, onto the internet web page. Patients received instant feedback from the system as to what dose to take and when the next test was due. During the routine care arm, patients attended the AMS at least every 4-6 weeks and were dosed by the anticoagulation pharmacist or physician. The primary outcome variable was the difference in the time in therapeutic range (TTR) between both arms.; One hundred and sixty-two patients were enrolled (male 61.6%, mean age 58.7 years), and 132 patients (81.5%) completed both arms. TTR was significantly higher during PST management than during AMS management (median TTR 74% vs 58.6%; z=5.67, P < 0.001).; The use of an internet-based, direct-to-patient expert system for the management of PST improves the control of OAT as compared with AMS management.
Item Type:
Article
Language:
en
Description:
BACKGROUND: Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT. METHODS: A prospective, randomized controlled cross-over study was performed to test the hypothesis that supervised PST using an internet-based, direct-to-patient expert system could provide improved anticoagulation control as compared with that provided by an anticoagulation management service (AMS). During the 6 months of supervised PST, patients measured their INR at home using a portable meter and entered this result, along with other information, onto the internet web page. Patients received instant feedback from the system as to what dose to take and when the next test was due. During the routine care arm, patients attended the AMS at least every 4-6 weeks and were dosed by the anticoagulation pharmacist or physician. The primary outcome variable was the difference in the time in therapeutic range (TTR) between both arms. RESULTS: One hundred and sixty-two patients were enrolled (male 61.6%, mean age 58.7 years), and 132 patients (81.5%) completed both arms. TTR was significantly higher during PST management than during AMS management (median TTR 74% vs 58.6%; z=5.67, P < 0.001). CONCLUSIONS: The use of an internet-based, direct-to-patient expert system for the management of PST improves the control of OAT as compared with AMS management.
MeSH:
Adolescent; Adult; Aged; Aged, 80 and over; Automation; Cross-Over Studies; Drug Monitoring; Equipment and Supplies; Expert Systems; Female; Humans; International Normalized Ratio; Internet; Male; Middle Aged; Patient Compliance; Self Care; Warfarin; Young Adult
ISSN:
1538-7836

Full metadata record

DC FieldValue Language
dc.contributor.authorRyan, Fen
dc.contributor.authorByrne, Sen
dc.contributor.authorO'Shea, Sen
dc.date.accessioned2012-01-09T16:16:00Z-
dc.date.available2012-01-09T16:16:00Z-
dc.date.issued2009-08-
dc.identifier.citationRandomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system. 2009, 7 (8):1284-90 J. Thromb. Haemost.en
dc.identifier.issn1538-7836-
dc.identifier.pmid19496921-
dc.identifier.doi10.1111/j.1538-7836.2009.03497.x-
dc.identifier.urihttp://hdl.handle.net/10147/200964-
dc.descriptionBACKGROUND: Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT. METHODS: A prospective, randomized controlled cross-over study was performed to test the hypothesis that supervised PST using an internet-based, direct-to-patient expert system could provide improved anticoagulation control as compared with that provided by an anticoagulation management service (AMS). During the 6 months of supervised PST, patients measured their INR at home using a portable meter and entered this result, along with other information, onto the internet web page. Patients received instant feedback from the system as to what dose to take and when the next test was due. During the routine care arm, patients attended the AMS at least every 4-6 weeks and were dosed by the anticoagulation pharmacist or physician. The primary outcome variable was the difference in the time in therapeutic range (TTR) between both arms. RESULTS: One hundred and sixty-two patients were enrolled (male 61.6%, mean age 58.7 years), and 132 patients (81.5%) completed both arms. TTR was significantly higher during PST management than during AMS management (median TTR 74% vs 58.6%; z=5.67, P < 0.001). CONCLUSIONS: The use of an internet-based, direct-to-patient expert system for the management of PST improves the control of OAT as compared with AMS management.en
dc.description.abstractIncreased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT.-
dc.description.abstractA prospective, randomized controlled cross-over study was performed to test the hypothesis that supervised PST using an internet-based, direct-to-patient expert system could provide improved anticoagulation control as compared with that provided by an anticoagulation management service (AMS). During the 6 months of supervised PST, patients measured their INR at home using a portable meter and entered this result, along with other information, onto the internet web page. Patients received instant feedback from the system as to what dose to take and when the next test was due. During the routine care arm, patients attended the AMS at least every 4-6 weeks and were dosed by the anticoagulation pharmacist or physician. The primary outcome variable was the difference in the time in therapeutic range (TTR) between both arms.-
dc.description.abstractOne hundred and sixty-two patients were enrolled (male 61.6%, mean age 58.7 years), and 132 patients (81.5%) completed both arms. TTR was significantly higher during PST management than during AMS management (median TTR 74% vs 58.6%; z=5.67, P < 0.001).-
dc.description.abstractThe use of an internet-based, direct-to-patient expert system for the management of PST improves the control of OAT as compared with AMS management.-
dc.language.isoenen
dc.subject.meshAdolescent-
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshAutomation-
dc.subject.meshCross-Over Studies-
dc.subject.meshDrug Monitoring-
dc.subject.meshEquipment and Supplies-
dc.subject.meshExpert Systems-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshInternational Normalized Ratio-
dc.subject.meshInternet-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPatient Compliance-
dc.subject.meshSelf Care-
dc.subject.meshWarfarin-
dc.subject.meshYoung Adult-
dc.titleRandomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system.en
dc.typeArticleen
dc.contributor.departmentPharmaceutical Care Research Group, University College Cork, Cork, Ireland.en
dc.identifier.journalJournal of thrombosis and haemostasis : JTHen
dc.description.provinceMunster-

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