Web-based self-management of anticoagulant therapy

A web-based solution has been developed, making it possible for self-managing patients in lifelong anticoagulation treatment to register and collect INR-values and medicine dose electronically.

Skejby Hospital in Århus has a so-called anticoagulation centre, where patients are instructed in self-management of anticoagulant therapy. The patients in question receive lifelong anticoagulation therapy because of arrhythmia, irregularities in the blood's ability to coagulate, or have had an artificial heart valve surgically implanted. The patient training programme runs over 27 weeks, commencing with an instruction in how to test own blood samples, followed by sessions in the course of which the responsibility for adjustment of anticoagulant dose is gradually transferred to the patient in accordance with a special schedule. The patients use a CoguCheck coagulometer for home tests of their INR (International Normalized Ratio), a standard measure of prothrombin time (PT), i.e. a measure of how long it takes the individual patient's blood to clot.

In 2003 two students at Aalborg University conducted a pilot study concerning the transmission of blood sample results, and the preliminary findings indicate that transmission may be achieved by use of existing equipment with the addition of simple telecommunications appliances via the internet. This tool facilitates better control with anticoagulant therapy on the part of both patients and anticoagulation centre staff, because both parties are able to view and assess INR values simultaneously. A randomized study with 150 patients will be conducted with two groups of patients at the outpatients anticoagulation centre at Skejby Hospital. On basis of review of literature effect hypothesis has been made:

- Patients take less blood samples of INR
- Patients following self-management anticoagulant therapy will be more responsible towards their own illness, i.e. enhanced self-care skills
- Patients following self-management anticoagulant therapy will enjoy a better regulation of their treatment
- Patients will have better control of their treatment evaluated by the time in the requested treatment interval.

Supported by Roche Diagnostics A/S.