Thromb Haemost 2010; 103(05): 1091-1101
DOI: 10.1160/TH09-07-0469
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Implementation of SintromacWeb®, a new internet-based tool for oral anticoagulation therapy telecontrol: Study on system consistency and patient satisfaction

Fernando Ferrando
1   Unidad de Hemostasia y Trombosis, Hospital Universitario La Fe, Valencia, Spain
,
Yolanda Mira
1   Unidad de Hemostasia y Trombosis, Hospital Universitario La Fe, Valencia, Spain
,
María Teresa Contreras
2   Servicio de Análisis Clínicos. Hospital Universitario La Fe, Valencia, Spain
,
Cristina Aguado
2   Servicio de Análisis Clínicos. Hospital Universitario La Fe, Valencia, Spain
,
José Antonio Aznar
1   Unidad de Hemostasia y Trombosis, Hospital Universitario La Fe, Valencia, Spain
› Author Affiliations
Financial support: This study was sponsored by Grifols.
Further Information

Publication History

Received: 21 July 2009

Accepted after major revision: 08 January 2010

Publication Date:
22 November 2017 (online)

Summary

Most computer- or internet-assisted systems for oral anticoagulation therapy (OAT) telemanagement have limitations when it comes to implementation within a healthcare center. It was the objective of this study to evaluate convenience and patient satisfaction with the use of SintromacWeb, a new OAT telecontrol system, compared with the conventional control. SintromacWeb® consists of a point-of-care device for patient international normalized ratio (INR) self-testing and software that allows internet mediated interaction with physicians. Patients initiated the use of SintromacWeb and were followed up during a three-month period. A score-based questionnaire was completed in three controlled visits, and data were subsequently analysed. A total of 102 patients were enrolled. At first visit, 55.7% of the patients had their INR within normal range, and 64.9% at the final visit. Internal consistency of the questionnaire was good (Cronbach‘s α: 0.79). Scores in the questionnaire were independent of patient’s age, education level, working status and INR value. The most valued features of SintromacWeb® were: fewer visits to the hospital, simplicity and convenience of the system, and time administration for control tasks (86.7%, 82.7% and 77.6% of very satisfied patients, respectively). Also, patients showed indifference or were dissatisfied with the conventional system. At the final visit, 99% of patients declared that they were satisfied with their OAT control. Moreover, all patients continued using Sintrom -acWeb after completion of the study. In conclusion, SintromacWeb telecontrol is a new model for management of anticoagulated patients. It was highly accepted and can be used by all patients regardless of their sociodemographic characteristics.

 
  • References

  • 1 Singer DE, Albers GW, Dalen JE. et al. Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (Suppl. 03) 429S-456S.
  • 2 Tran H, McRae S, Ginsberg J. Anticoagulant treatment of deep vein thrombosis and pulmonary embolism. Clin Geriatr Med 2006; 22: 113-134.
  • 3 Oake N, Jennings A, Forster AJ. et al. Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis. CMAJ 2008; 179: 235-244.
  • 4 Eckman MH, Levine HJ, Pauker SG. Effect of laboratory variation in the prothrombin-time ratio on the results of oral anticoagulant therapy. N Engl J Med 1993; 329: 696-702.
  • 5 Loeliger EA, van den Besselaar AM, Lewis SM. Reliability and clinical impact of the normalization of the prothrombin times in oral anticoagulant control. Thromb Haemost 1985; 53: 148-154.
  • 6 Nichols WL, Bowie EJW. Standardization of the prothrombin time for monitoring orally administered anticoagulant therapy with use of the international normalized ration system. Mayo Clin Proc 1993; 68: 897-898.
  • 7 Fitzmaurice DA, Hobbs FD, Murray ET. et al. Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing: a randomized, controlled trial. Arch Intern Med 2000; 160: 2343-2348.
  • 8 Christensen TD, Maegaard M, Sorensen HT. et al. Self- versus conventional management of oral anticoagulant therapy: effects on INR variability and coumarin dose in a randomized controlled trial. Am J Cardiovasc Drugs 2007; 07: 191-197.
  • 9 Bluestein D, Brantley C, Barnes-Eley M. et al. Measuring international normalized ratios in long-term care: a comparison of commercial laboratory and point-of-care device results. J Am Med Dir Assoc 2007; 08: 404-408.
  • 10 Bauman ME, Black KL, Massicotte MP. et al. Accuracy of the CoaguChek XS for point-of-care international normalized ratio (INR) measurement in children requiring warfarin. Thromb Haemost 2008; 99: 1097-1103.
  • 11 Greenway A, Ignjatovic V, Summerhayes R. et al. Point-of-care monitoring of oral anticoagulation therapy in children. Comparison of the CoaguChek XS system with venous INR and venous INR using an International Reference Thromboplastin preparation (rTF/95). Thromb Haemost 2009; 102: 159-165.
  • 12 Torreiro EG, Fernández EG, Rodríguez RM. et al. Comparative study of accuracy and clinical agreement of the CoaguChek XS portable device versus standard laboratory practice in unexperienced patients. Thromb Haemost 2009; 101: 969-974.
  • 13 Christensen TD, Larsen TB, Jensen C. et al. International normalised ratio (INR) measured on the CoaguChek S and XS compared with the laboratory for determination of precision and accuracy. Thromb Haemost 2009; 101: 563-569.
  • 14 Fitzmaurice DA, Murray ET, Gee KM. et al. A randomised controlled trial of patient self management of oral anticoagulation treatment compared with primary care management. J Clin Pathol 2002; 55: 845-849.
  • 15 Sunderji R, Gin K, Shalansky K. et al. A randomized trial of patient self-managed versus physician-managed oral anticoagulation. Can J Cardiol 2004; 20: 1117-1123.
  • 16 Menendez-Jandula B, Souto JC, Oliver A, Montserrat I, Quintana M, Gich I, Bon-fill X, Fontcuberta J. Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial. Ann Intern Med 2005; 142: 1-10.
  • 17 Regier DA, Sunderji R, Lynd LD. et al. Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy. CMAJ 2006; 174: 1847-1852.
  • 18 Christensen TD, Johnsen SP, Hjortdal VE. et al. Self-management of oral anticoagulant therapy: a systematic review and meta-analysis. Int J Cardiol 2007; 118: 54-61.
  • 19 Siebenhofer A, Rakovac I, Kleespies C. et al. SPOG 60+ Study Group.. Self-management of oral anticoagulation reduces major outcomes in the elderly. A randomized controlled trial. Thromb Haemost 2008; 100: 1089-1098.
  • 20 Gardiner C, Williams K, Mackie IJ. et al. Can oral anticoagulation be managed using telemedicine and patient self-testing? A pilot study. Clin Lab Haematol 2006; 28: 122-125.
  • 21 Testa S, Alatri A, Paoletti O. et al. Reorganisation of an anticoagulation clinic using a telemedicine system: description of the model and preliminary results. Intern Emerg Med 2006; 01: 24-29.
  • 22 Salvador CH, Ruiz-Sanchez A, Gonzalez de Mingo MA. et al. Evaluation of a tele-medicine-based service for the follow-up and monitoring of patients treated with oral anticoagulant therapy. IEEE Trans Inf Technol Biomed 2008; 12: 696-706.
  • 23 O’Shea SI, Arcasoy MO, Samsa G. et al. Direct-to-patient expert system and home INR monitoring improves control of oral anticoagulation. J Thromb Thrombolysis 2008; 26: 14-21.
  • 24 Ryan F, Byrne S, O’Shea S. Randomised controlled trial of supervised patient self-testing of warfarin therapy using an internet based expert system. J Thromb Haemost 2009; 07: 1284-1290.
  • 25 Bereznicki LR, Peterson GM, Jackson SL. et al. The risks of warfarin use in the elderly. Expert Opin Drug Saf 2006; 05: 417-431.
  • 26 Fritschi J, Raddatz-Muller P, Schmid P. et al. Patient self-management of long-term oral anticoagulation in Switzerland. Swiss Med Wkly 2007; 137: 252-258.
  • 27 Ansell J, Hirsh J, Hylek E. et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl. 06) 160S-198S.
  • 28 Taborski U, Braun SL, Völler H. Analytical performance of the new coagulation monitoring system INRatio for the determination of INR compared with the coagulation monitor Coaguchek S and an established laboratory method. J Thromb Thrombolysis 2004; 18: 103-107.
  • 29 Ferrando F, Mira Y, Contreras MT. et al. Estudio piloto para evaluar el grado de satisfacción del paciente con Sintromac-Web: una herramienta para el telecontrol de la terapia anticoagulante oral. Haematologica 2008; 93 (Suppl. 02) 133.
  • 30 Murray ET, Fitzmaurice DA, Allan TF. et al. A primary care evaluation of three near patient coagulometers. J Clin Pathol 1999; 52: 842-845.
  • 31 Ryan F, O’Shea S, Byrne S. The reliability of point-of-care prothrombin time testing. A comparison of CoaguChek S and XS INR measurements with hospital laboratory monitoring. Int J Lab Hematol 2010; 32: e26-33.
  • 32 Logan EC, Auger MJ, Cotton P. et al. Monitoring oral anticoagulation in primary care. Shared care can work. Br Med J 1996; 313: 819.
  • 33 Blann AD, Fitzmaurice DA, Lip GY. Anticoagulation in hospitals and general practice. Br Med J 2003; 326: 153-156.
  • 34 Sawicki PT, Gläser B, Kleespies C. et al. Self-management of oral anticoagulation: long-term results. J Intern Med 2003; 254: 515-516.
  • 35 Hambleton J. Home monitoring of anticoagulation. J Thromb Thrombolysis 2003; 16: 39-42.
  • 36 Gardiner C, Williams K, Mackie IJ. et al. Patient self-testing is a reliable and acceptable alternative to laboratory INR monitoring. Br J Haematol 2005; 128: 242-247.
  • 37 Pence C, McErlane K. Anticoagulation self-monitoring. Am J Nurs 2005; 105: 62-65.
  • 38 McCahon D, Murray ET, Jowett S. et al. Patient self management of oral anticoagulation in routine care in the UK. J Clin Pathol 2007; 60: 1263-1267.
  • 39 Lancaster TR, Singer DE, Sheehan MA. et al. The impact of long-term warfarin therapy on quality of life. Evidence from a randomized trial. Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. Arch Intern Med 1991; 151: 1944-1949.
  • 40 Harrison L, McGinnis J, Crowther M. et al. Assessment of outpatient treatment of deep-vein thrombosis with low-molecular-weight heparin. Arch Intern Med 1998; 158: 2001-2003.
  • 41 Sawicki PT. A structured teaching and self-management program for patients receiving oral anticoagulation: a randomized controlled trial. Working Group for the Study of Patient Self-Management of Oral Anticoagulation. J Am Med Assoc 1999; 281: 145-150.
  • 42 Gadisseur AP, Kaptein AA, Breukink-Engbers WG. et al. Patient self-management of oral anticoagulant care vs. management by specialized anticoagulation clinics: positive effects on quality of life. J Thromb Haemost 2004; 02: 584-591.
  • 43 Samsa G, Matchar DB, Dolor RJ. et al. A new instrument for measuring anticoagulation-related quality of life: development and preliminary validation. Health Qual Life Outcomes 2004; 02: 22.
  • 44 Cromheecke ME, Levi M, Colly LP. et al. Oral anticoagulation self-management and management by a specialist anticoagulation clinic: a randomised cross-over comparison. Lancet 2000; 356: 97-102.
  • 45 Finkelstein J, Khare R, Ansell J. Feasibility and patient acceptance of Home Automated Telemanagement of oral anticoagulation therapy. AMIA Annu Symp Proc 2003; 230-234.