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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).

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Date
2010-10
Authors
Dolor, Rowena J
Ruybalid, R Lynne
Uyeda, Lauren
Edson, Robert G
Phibbs, Ciaran
Vertrees, Julia E
Shih, Mei-Chiung
Jacobson, Alan K
Matchar, David B
THINRS Site Investigators
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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.
Type
Journal article
Subject
THINRS Site Investigators
Humans
Atrial Fibrillation
Hemorrhage
Warfarin
Anticoagulants
Drug Monitoring
International Normalized Ratio
Prothrombin Time
Self Care
ROC Curve
Heart Valve Prosthesis
Patient Selection
Adult
Aged
Aged, 80 and over
Middle Aged
Costs and Cost Analysis
Female
Male
Young Adult
Permalink
https://hdl.handle.net/10161/22913
Published Version (Please cite this version)
10.1007/s11239-010-0499-8
Publication Info
Dolor, Rowena J; Ruybalid, R Lynne; Uyeda, Lauren; Edson, Robert G; Phibbs, Ciaran; Vertrees, Julia E; ... THINRS Site Investigators (2010). 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). Journal of thrombosis and thrombolysis, 30(3). pp. 263-275. 10.1007/s11239-010-0499-8. Retrieved from https://hdl.handle.net/10161/22913.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Dolor

Rowena Joy Dolor

Professor of Medicine
Rowena J. Dolor, MD, MHS did her medical training and internal medicine residency at Duke University Medical Center. She completed the Ambulatory Care/Health Services Research fellowship at the Durham VA Medical Center in 1996 and obtained her Masters in Health Sciences degree in Biometry (renamed MHS in Clinical Research) from the Duke University School of Medicine in 1998. Dr. Dolor was a staff physician in the Ambulatory Care Service at the Durham VA Medical Center and Research Associate at t
Matchar

David Bruce Matchar

Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention. Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analy
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