Article

Journal of Thrombosis and Thrombolysis

, Volume 30, Issue 3, pp 263-275

An evaluation of patient self-testing competency of prothrombin time for managing anticoagulation: pre-randomization results of VA Cooperative Study #481–The Home INR Study (THINRS)

  • Rowena J. DolorAffiliated withCenter for Health Services Research in Primary Care, VA Medical CenterDivision of General Internal Medicine, Department of Medicine, and Center for Clinical Health Policy Research, Duke University Medical CenterDuke Clinical Research Institute Email author 
  • , R. Lynne RuybalidAffiliated withResearch and Development Service (151), Jerry L. Pettis VA Medical Center
  • , Lauren UyedaAffiliated withCooperative Studies Program Coordinating Center (151K), VA Palo Alto Health Care System
  • , Robert G. EdsonAffiliated withCooperative Studies Program Coordinating Center (151K), VA Palo Alto Health Care System
  • , Ciaran PhibbsAffiliated withHealth Economics Resource Center, VA Palo Alto Health Care SystemDepartment of Pediatrics and Center for Primary Care and Outcomes Research, Stanford University School of Medicine
  • , Julia E. VertreesAffiliated withVA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center
  • , Mei-Chiung ShihAffiliated withCooperative Studies Program Coordinating Center (151K), VA Palo Alto Health Care SystemDivision of Biostatistics, Department of Health Research and Policy, Stanford University
  • , Alan K. JacobsonAffiliated withResearch and Development Service (151), Jerry L. Pettis VA Medical CenterDepartment of Internal Medicine, Loma Linda University
  • , David B. MatcharAffiliated withCenter for Health Services Research in Primary Care, VA Medical CenterDivision of General Internal Medicine, Department of Medicine, and Center for Clinical Health Policy Research, Duke University Medical CenterProgram in Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School

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Abstract

Prior studies suggest patient self-testing (PST) of prothrombin time (PT) can improve the quality of anticoagulation (AC) and reduce complications (e.g., bleeding and thromboembolic events). “The Home INR Study” (THINRS) compared AC management with frequent PST using a home monitoring device to high-quality AC management (HQACM) with clinic-based monitoring on major health outcomes. A key clinical and policy question is whether and which patients can successfully use such devices. We report the results of Part 1 of THINRS in which patients and caregivers were evaluated for their ability to perform PST. Study-eligible patients (n = 3643) were trained to use the home monitoring device and evaluated after 2–4 weeks for PST competency. Information about demographics, medical history, warfarin use, medications, plus measures of numeracy, literacy, cognition, dexterity, and satisfaction with AC were collected. Approximately 80% (2931 of 3643) of patients trained on PST demonstrated competency; of these, 8% (238) required caregiver assistance. Testers who were not competent to perform PST had higher numbers of practice attempts, higher cuvette wastage, and were less able to perform a fingerstick or obtain blood for the cuvette in a timely fashion. Factors associated with failure to pass PST training included increased age, previous stroke history, poor cognition, and poor manual dexterity. A majority of patients were able to perform PST. Successful home monitoring of PT with a PST device required adequate levels of cognition and manual dexterity. Training a caregiver modestly increased the proportion of patients who can perform PST.

Keywords

Anticoagulation Patient self-testing Atrial fibrillation Mechanical heart valve