Overcoming Barriers to Warfarin Patient Self-management Implementation in the US Healthcare System
University of Utah
Summary
In the US, patients receiving warfarin therapy are rarely allowed to engage in patient self-management (PSM) which is less burdensome, less expensive, and safer than standard clinic-directed warfarin management. The long-term objective of our application is to improve the safety of ambulatory warfarin therapy through increasing the implementation of PSM.
Description
In the US, patients receiving warfarin therapy are rarely allowed to engage in patient self-management (PSM) which is less burdensome, less expensive, and safer than standard clinician-directed warfarin management. National and international evidence-based guideline panels strongly recommend PSM over other warfarin management methods for appropriate patients because it improves INR control, cuts risk of thrombosis and death by half without increasing bleeding risk, and increases patient satisfaction and quality of life. The reasons behind PSM underutilization in US settings have not been syste…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * At least 18 years of age treated with warfarin for any indication for at least 9 months prior to enrollment * Demonstrate the willingness and ability to test their own INR using a home INR monitoring device or have same-day access to clinic-derived INR results (e.g., via electronic medical record secure messaging) * Willing to make independent decisions about warfarin dosing based on INR results * Able to perform INR tests at least every 2 weeks * Currently have and willing to maintain internet access for the duration of the study in order to complete online data collect…
Interventions
- OtherPatient self-management
Patient makes independent decisions regarding warfarin therapy changes using warfarin dosing tools
- OtherUsual care provided by anticoagulation providers
Normal care provided by anticoagulation providers
Locations (4)
- VA Loma Linda Healthcare SystemLoma Linda, California
- Brigham and Women's HospitalBoston, Massachusetts
- University of MichiganAnn Arbor, Michigan
- University of Utah Thrombosis CenterSalt Lake City, Utah