title: 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).
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.
authors.affiliation: Center for Health Services Research in Primary Care, VA Medical Center, Durham, NC, USA. rowena.dolor@duke.edu
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.forename: R Lynne
authors.initials: RL
authors.lastname: Ruybalid
authors.forename: Lauren
authors.initials: L
authors.lastname: Uyeda
authors.forename: Robert G
authors.initials: RG
authors.lastname: Edson
authors.forename: Ciaran
authors.initials: C
authors.lastname: Phibbs
authors.forename: Julia E
authors.initials: JE
authors.lastname: Vertrees
authors.forename: Mei-Chiung
authors.initials: MC
authors.lastname: Shih
authors.forename: Alan K
authors.initials: AK
authors.lastname: Jacobson
authors.forename: David B
authors.initials: DB
authors.lastname: Matchar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation; D003365:Costs and Cost Analysis; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D005260:Female; D006350:Heart Valve Prosthesis; D006470:Hemorrhage; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011517:Prothrombin Time / Q000295:instrumentation / Q000379:methods*; D012372:ROC Curve; D012648:Self Care / Q000295:instrumentation* / Q000379:methods; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin