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Patient self-management of oral anticoagulation and external quality assessment procedures
E T Murray1, D P Kitchen, S Kitchen
1Department of Primary Care and General Practice, The Medical School, University of Birmingham, Edgbaston, Birmingham, UK. e.t.murray@bham.ac.uk
Insights
Patients can effectively perform external quality assessment (EQA) for self-managed oral anticoagulation. Their results using the UK National External Quality Assessment Scheme (NEQAS) closely matched those of healthcare professionals.
Area of Science:
- Clinical Chemistry
- Pharmacology
- Patient Self-Management
Background:
- External quality assessment (EQA) for patient self-management (PSM) of oral anticoagulation is debated.
- Previous studies have not fully evaluated patient EQA competence.
Purpose of the Study:
- To compare the efficacy of patient versus healthcare professional EQA procedures in PSM of oral anticoagulation.
- To assess patient competence in performing EQA using the UK National External Quality Assessment Scheme (NEQAS).
Main Methods:
- 23 patients on PSM using Coaguchek performed EQA twice unsupervised at home and twice supervised in practice.
- Patient EQA results were compared with 75 healthcare professionals using Coaguchek S and NEQAS.
- International Normalized Ratio (INR) percentage time in range for the PSM group was calculated.
Main Results:
- The PSM group achieved 74% time in therapeutic INR range.
- No significant difference was found between patient and professional median NEQAS results.
- Patients demonstrated competence, with coefficients of variation between 5.4% and 22.3%.
Conclusions:
- Patients can competently perform EQA for oral anticoagulation self-management.
- Patient and professional EQA results show good agreement, supporting PSM efficacy.
- Further research is needed to link EQA precision to treatment stability in PSM.
Abstract:
The role of external quality assessment (EQA) is a contentious issue for patient self-management (PSM) of oral anticoagulation. Patients from general practices in the West Midlands undertaking PSM were recruited to compare efficacy of patients' and health professionals' EQA procedure using the UK National External Quality Assessment Scheme (NEQAS). Patients using Coaguchek (Roche Diagnostics) were trained to perform EQA as part of their PSM training. They undertook PSM for 26 weeks and were asked to perform EQA using material provided by the UK NEQAS twice at home without supervision and twice at the practice with supervision. Patients' results were compared with health care professional users of Coaguchek S. Twenty-three PSM patients were compared with 75 health care professional users of the NEQAS scheme. The PSM group international normalized ratio (INR) percentage time in range was 74%. There was no significant difference in the median results on NEQAS samples obtained by the patients and those obtained by professionals. Three patients were outwith consensus (results > 15% from the median INR) on more than one occasion. Patients were able to perform the EQA tests competently. The data show that good agreement can be achieved between patients analysing the same EQA samples, with coefficients of variation ranging from 22.3% to as low as 5.4%. Further study is required to determine how precision within these EQA schemes relates to the stability of treatment in patients' management of their own anticoagulation.