title: Home INR monitoring of oral anticoagulant therapy in children using the CoaguChek S point-of-care monitor and a robust education program.
abstract: BACKGROUND
  Management strategies such as self-monitoring of anticoagulant therapy have been reported with increased frequency. Whilst patient education is frequently mentioned, details regarding the educational interventions employed are scarce. This study aimed to improve the outcomes of home monitoring of warfarin therapy in children through the development and implementation of a robust intervention, based upon the PRECEDE model of education.
  
  
  METHODS
  Participating parents had to complete an intensive education and training program. After demonstrating practical and theoretical competency, parents commenced home monitoring. Every second scheduled home INR (H-INR) required a paired INR on the same day, obtained by a trained pathology collector (C-INR). Demographic and statistical outcome data was collected.
  
  
  RESULTS
  Parental understanding of warfarin therapy improved significantly following the educational intervention (p<0.0001). 65.5% of H-INRs and 64.4% of C-INRs were within the target range (ns). Lin's correlation coefficient between H-INRs and C-INRs was 0.949. There were no warfarin-related adverse events.
  
  
  CONCLUSIONS
  This study demonstrated a significant improvement in parental knowledge following participation in a robust educational intervention. Furthermore, compared to previous reports in children, a greater level of correlation between home and hospital-based INRs was achieved by participating parents. The use of similar educational interventions may serve to improve the outcomes of similar management strategies.
authors.affiliation: Department of Clinical Haematology, Royal Children's Hospital, Melbourne, Australia. fiona.newall@rch.org.au
authors.forename: Fiona
authors.initials: F
authors.lastname: Newall
authors.forename: Paul
authors.initials: P
authors.lastname: Monagle
authors.forename: Linda
authors.initials: L
authors.lastname: Johnston
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage; D002648:Child; D019544:Equipment Failure Analysis; D006701:Home Nursing / Q000193:education* / Q000379:methods*; D006801:Humans; D019934:International Normalized Ratio / Q000295:instrumentation*; D008991:Monitoring, Physiologic / Q000295:instrumentation; D010290:Parents / Q000193:education*; D019095:Point-of-Care Systems; D011517:Prothrombin Time / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin