title: The patients' perspective of international normalized ratio self-testing, remote communication of test results and confidence to move to self-management.
abstract: OBJECTIVE
  To elicit the perceptions of patients, who self-tested their international normalized ratio and communicated their results via a text or phone messaging system, to determine their satisfaction with the education and support that they received and to establish their confidence to move to self-management.
  
  
  BACKGROUND
  Self-testing of international normalized ratio has been shown to be reliable and is fast becoming common practice. As innovations are introduced to point of care testing, more research is needed to elicit patients' perceptions of the self-testing process.
  
  
  METHODS
  This three site study used a cross-sectional prospective descriptive survey.
  
  
  METHODS
  Three hundred and thirty patients who were prescribed warfarin and using international normalized ratio self-testing were invited to take part in the study. The anonymous survey examined patient profile, patients' usage, issues, perceptions, confidence and satisfaction with using the self-testing system and their preparedness for self-management of warfarin dosage.
  
  
  RESULTS
  The response rate was 57% (n = 178). Patients' confidence in self-testing was high (90%). Patients expressed a high level of satisfaction with the support received, but expressed the need for more information on support groups, side effects of warfarin, dietary information and how to dispose of needles. When asked if they felt confident to adjust their own warfarin levels 73% agreed. Chi-squared tests for independence revealed that none of the patient profile factors examined influenced this confidence. The patients cited the greatest advantages of the service were reduced burden, more autonomy, convenience and ease of use. The main disadvantages cited were cost and communication issues.
  
  
  CONCLUSIONS
  Patients were satisfied with self-testing. The majority felt they were ready to move to self-management.
  
  
  CONCLUSIONS
  The introduction of innovations to remote point of care testing, such as warfarin self-testing, needs to have support at least equal to that provided in a hospital setting.
authors.affiliation: St. James's Hospital, Dublin 8, Ireland.
authors.forename: Anne
authors.initials: A
authors.lastname: Grogan
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Coughlan
authors.affiliation: Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Prizeman
authors.affiliation: St. James's Hospital, Dublin 8, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: O'Connell
authors.affiliation: Naas General Hospital, Naas, Co Kildare, Ireland.
authors.forename: Nora
authors.initials: N
authors.lastname: O'Mahony
authors.affiliation: Anticoagulation Service, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: Katherine
authors.initials: K
authors.lastname: Quinn
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland.
authors.forename: Gabrielle
authors.identifier: http://orcid.org/0000-0003-0211-5330
authors.initials: G
authors.lastname: McKee
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D019934:International Normalized Ratio / Q000523:psychology / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012648:Self Care / Q000379:methods* / Q000523:psychology; D000073278:Self-Management / Q000379:methods; D011795:Surveys and Questionnaires; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulant treatment; international normalized ratio; point of care; self-management; self-testing; warfarin