title: Impact of a new method of warfarin management on patient satisfaction, time, and cost.
abstract: OBJECTIVE
  International normalized ratio self-testing with online remote monitoring and management (STORM₂) is an alternative to anticoagulation clinic management, but the patient's perspective of this method has not been evaluated in the United States; thus we sought to evaluate the impact of STORM₂ on patient satisfaction, time, and cost.
  
  
  METHODS
  Prospective pre- and postintervention study.
  
  
  METHODS
  Freestanding clinical research center.
  
  
  METHODS
  Forty-three patients treated with long-term warfarin therapy and monitored initially in the anticoagulation clinic setting and then with STORM₂, referred from 11 medical practices.
  
  
  METHODS
  Patients were asked to complete a survey and the Duke Anticoagulation Satisfaction Scale (DASS) before (at baseline) and after at least 3 months of STORM₂ (at follow-up).
  
  
  RESULTS
  Patient satisfaction and time were assessed by survey and the DASS. Costs were measured from the patient's perspective. Overall 90% of responders preferred STORM₂ to traditional clinic management. The DASS questions indicated that patients were more satisfied with their anticoagulation treatment and more likely to recommend oral anticoagulation to a friend after experiencing STORM₂. In addition, patients found STORM₂ to be less complicated and more convenient than traditional clinic management. For each traditional monthly visit, patients drove 20 miles and expended a total of 1.8 hours; using 55¢/mile for mileage reimbursement and $15/hour for lost wages, the cost for each visit was $38. The total cost for four STORM₂ visits per month was $10, for a net savings of $28 per patient per month. A total of 76% of patients were willing to pay additional money to eliminate a monthly clinic visit.
  
  
  CONCLUSIONS
  STORM₂ is more convenient, less complicated, preferred by patients, and saves patients time and money compared with clinic management.
authors.affiliation: College of Pharmacy, The University of Texas, Austin, Texas; The University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Sarah
authors.initials: S
authors.lastname: Meyer
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Frei
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Daniels
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Forcade
authors.forename: Marie
authors.initials: M
authors.lastname: Bussey
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Bussey-Smith
authors.forename: Henry I
authors.initials: HI
authors.lastname: Bussey
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D019468:Disease Management; D016903:Drug Monitoring / Q000191:economics / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D019934:International Normalized Ratio / Q000191:economics* / Q000379:methods*; D008297:Male; D017060:Patient Satisfaction / Q000191:economics*; D011446:Prospective Studies; D012648:Self Care / Q000191:economics* / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulation; cost; home INR monitoring; self-testing; warfarin