External quality assessment for warfarin dosing using computerised decision support software

Patient compliance with an anticoagulation management system based on a smartphone application

We developed a novel anticoagulation management system (Anticlot Assistant) based on a smartphone application (App). This study was performed to evaluate patient compliance with Anticlot Assistant. This prospective case series study involved patients receiving warfarin therapy. The eligible patients were managed via Anticlot Assistant, and outcome data were analyzed. Thirty patients were recruited. The mean time within the therapeutic range (TTR) was 56.5% ± 26.2% and the mean patient compliance with Anticlot Assistant was 52.7% ± 40.4%. The patients in good compliance group had higher TTR (65.6 ± 25.0% vs. 40.0 ± 21.0%, P = 0.009), lower time in the extremely low range (9.4 ± 10.6% vs. 27.4 ± 13.2%, P = 0.000) and in the extremely high range (1.3 ± 2.8% vs. 14.1 ± 22.3%, P = 0.004) than those in poor compliance group. Logistic regression analysis revealed that receiving an education of > 6 years was the only independent predictor of good compliance (odds ratio 8.400, 95% confidence interval 1.274-55.394, P = 0.027). Patient compliance is critical important for good outcomes and it might increase with improvements in education and more widespread use of information technology. Although further improvement is needed, Anticlot Assistant is promising and this study offered valuable experiences for further research.

Introduction of point-of-care testing in Japanese outpatient clinics is associated with improvement in time in therapeutic range in anticoagulant-treated patients

BACKGROUND

Warfarin reduces the risk of stroke in patients with atrial fibrillation, but requires a moderate-to-high time in therapeutic range (TTR). We hypothesized that point-of-care (POC) testing for prothrombin time-internationalized normalized ratio (PT-INR) could improve the TTR in patients receiving warfarin.

METHODS AND RESULTS

Eight outpatient clinics that introduced POC testing for PT-INR participated in this study. We identified 148 consecutive patients who received warfarin for at least 12 months before and after the introduction of POC testing. We compared the TTR before and after the introduction of POC testing for each patient. TTR after the introduction of POC testing was significantly higher than that beforehand (51.9%±33.0% vs. 69.3%±26.3%; P<0.0001). The improvement in TTR was statistically significant in patients who had low TTR (<70%) before the introduction of POC testing. After the introduction of POC, the time spent above the target INR showed no significant change (3.7%±10.6% vs. 3.3%±6.3%, P=0.7322), while that spent below the target INR improved significantly (44.4%±34.4% vs. 27.4%±27.6%, P<0.0001).

CONCLUSIONS

The introduction of POC testing was associated with an improvement in TTR, mainly through a reduction in the time spent below the target INR.

An evaluation of near-patient testing of anticoagulant control in general practice

PURPOSE

This paper aims to compare anticoagulant management in secondary care for the year prior to the introduction of near-patient testing in a general practice, and in the subsequent year after it was introduced.

DESIGN/METHODOLOGY/APPROACH

This paper is a retrospective, paired before-after study. Details of test results in the two-year-long periods on the 46 patients who met the inclusion criteria were collected and analysed pairwise.

FINDINGS

Despite an increase in the frequency of testing this set of patients were controlled as well in general practice as they had been with a secondary-care service, and better that in a number of studies in the literature.

RESEARCH LIMITATIONS/IMPLICATIONS

This research reviews a recently introduced service at a single centre. Further research of patient satisfaction and adverse events in a multi-centre longer-term trial are desirable.

PRACTICAL IMPLICATIONS

Technology now allows the increasing amount of individuals on anticoagualtion to be controlled with near-patient testing in general practice. This study shows that satisfactory control can be maintained in patients who transfer from a secondary care-based to a primary care-based service.

ORIGINALITY/VALUE

This paper demonstrates that a single general practice can provide a high quality anticoagulant service using near-patient testing and computer-based decision support. This adds to the already available evidence and will hopefully encourage other practices to adopt the same.