title: ProTime self-management yielding improvement of fluency and quality of life.
abstract: Patient self-management (PSM), as the standard of care for vitamin K-antagonist therapy management in Germany requires a detailed, point-of-care (POC) device-specific training program to ensure quality patient care. In a multi-center trial using the ProTime System (Training program plus POC device), 105 patients were enrolled to evaluate efficacy of training, knowledge retention, patient satisfaction and quality of life (QoL). Patients returned to the centers 1, 3 and 6 months after training to complete questionnaires and demonstrate INR test proficiency. Training assessment employed self-evaluation and comparison of POC results between PSM and professional operators. Patient satisfaction and QoL were assessed using a modification of the questionnaire described by Sawicki and the SF12v2 QoL Survey, respectively. Patients demonstrated statistically significant improvements in knowledge post training (p < 0.001) and retained the acquired information (p = NS vs. post-training; N = 45) after 6 months. Trained patients yielded equivalent INR results to professional operators (r = 0.92) with little or no bias across all clinic visits. Compliance with weekly testing improved from 1 to 3 months (p = 0.03), remaining at the required weekly frequency through 6 months. Average patient satisfaction improved significantly during the first month and remained constant thereafter. There was a statistically significant improvement in the Physical Component Summary of SF12 between baseline and 3/6 month assessments in all centers. In conclusion, PSM requires a comprehensive system including appropriate disease and POC device training. Such a system fosters compliance, improved knowledge about underlying disease, patient satisfaction and QoL.
authors.affiliation: Klinik Am See, Rüdersdorf, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Völler
authors.forename: Uwe
authors.initials: U
authors.lastname: Taborski
authors.forename: Clemens
authors.initials: C
authors.lastname: Dovifat
authors.forename: Ines
authors.initials: I
authors.lastname: Hartwig
authors.forename: Janos G
authors.initials: JG
authors.lastname: Kadar
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Zucker
authors.forename: Frank M
authors.initials: FM
authors.lastname: LaDuca
authors.forename: Jack
authors.initials: J
authors.lastname: Ansell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D005858:Germany; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011517:Prothrombin Time; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D014812:Vitamin K