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ePaper created 2014-10-06, 13:17:01 | version 1.33.00
intelligent Electronic Patient Record and a suitable algorithm for management of dose adjustment, but also depends on reliable and accurate point of care testing devices. While the benefits of PST/PSM have been established, there has been no large scale comparison of the effect of different INR monitors on clinical outcomes. The current analysis seeks to address this question by retrospectively examining the large database of the National Thrombosis Service (NTS), TK Ede, the Netherlands, which records relevant parameters for patients’ measurements and clinical outcomes, allowing for identification of trends and correlations. Time in therapeutic range (TTR) is widely accepted as a valid surrogate parameter for the clinical effectiveness and safety of VKA anticoagulant treatment [4, 15–18]. The level of INR variation and the number of critical INR values (INR \1.5 or [5.0) have also been discussed as surrogate parameters specifically addressing the risk of adverse events [8, 19, 20]. The current analysis aims to observe the clinical impact of the different INR measurement devices on the coagulation control parameters as well as on the overall clinical outcomes. METHODS Description of the NTS The NTS was established in 2006 and has developed an extensive patient support service, comprised of e-learning, user-friendly, intelligent software, one-on-one instruction and education, 24/7 medical service desk, 6-weekly newsletters and various reminder services to optimally motivate, support and develop ‘good patientship’. Potential users of NTS self-care establish contact with the NTS through the internet, and NTS staff follow up within 24 h through telephone contact. The goal is to make sure that the patients have purposefully made contact with the NTS and then to establish their eligibility for INR self-testing at home. Patient eligibility is based on the patient’s level of understanding, motivation to self-care, ability and willingness to perform the blood test itself and available technology (computer/mobile device with internet access), with no influence of age or disease severity. Eligible patients are then provided with access to and support for a number of e-learning modules about thrombosis, anticoagulation, INR measurement, the advantages and the responsibilities of self-care, the practical and technical implications of self-care and (voluntary) self-dosing. Those who pass a mandatory certification go on to execute a practice test, at home or at work, in the presence of a qualified NTS nurse, using the monitor to measure their INR and practising the use of the Electronic Patient Record. Patients who pass the practice test are accepted for self- testing by the NTS. Patients who express the interest to become fully self-managing will first gather 3 months of experience in the PST model before entering into the advanced program for PSM. Patients who do not meet the requirements will not be accepted; approximately 53% of all patients who make contact via the NTS website go on to home- monitor (33% drop out during first telephone contact, 10% are unwilling or unable to complete e-learning, 4% drop out during the intake process or the first 4 weeks). Of the patients on home-monitoring in this analysis, 80% were on PST and 20% were willing and able to perform PSM. Patients then start to measure their INR and record the measurement result on the system, and answer questions regarding their clinical Adv Ther