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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Supervised patient self-testing of warfarin therapy using an online system
Luke Ryan Elliot Bereznicki1, Shane Leigh Jackson, Gregory Mark Peterson
1Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Hobart 7001, Australia. Luke.Bereznicki@utas.edu.au
Journal of Medical Internet Research
|July 16, 2013
Summary
Patient self-testing (PST) of warfarin therapy using an online supervision system significantly improved international normalized ratio (INR) control in elderly patients. This home-based monitoring strategy enhanced clinical outcomes compared to traditional laboratory testing.
Area of Science:
- Pharmacology and Therapeutics
- Digital Health and Telemedicine
- Geriatric Medicine
Background:
- Point-of-care international normalized ratio (INR) monitoring devices facilitate warfarin management through patient self-testing (PST) at home.
- PST has demonstrated improved clinical outcomes for warfarin therapy compared to standard care.
Purpose of the Study:
- To compare warfarin therapy management using PST with online physician supervision against usual care involving laboratory testing and physician dosing.
- To evaluate the efficacy of a custom online system for remote patient monitoring and management.
Main Methods:
- Recruited patients from community pharmacies for warfarin PST training, requiring long-term warfarin use and internet access.
- Patients performed weekly INR monitoring for up to 3 months, utilizing a secure website for communication with physicians.
- Primary outcome was the percentage of time within the therapeutic INR range (TTR), with participants serving as their own historical controls.
Main Results:
- A significant improvement in TTR was observed, increasing from 66.4% to 78.4% during PST (P=.01).
- The percentage of INR tests within the target range also significantly improved from 66.0% to 75.9% (P=.04).
- Both patients and physicians reported high satisfaction with the online monitoring system and strategy.
Conclusions:
- PST, supported by an online supervision system, led to improved INR control in elderly patients compared to usual care.
- Further research is recommended to explore the clinical outcomes and cost-effectiveness of online systems for home-based chronic condition management.
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