HEALTH MATTERS 11 warFarin


Managing Warfarin Therapy Online


is the Future Managing chronic or long-term disease is becoming a major challenge in the modern world. Increasingly we are trying to find more effective approaches to manage these diseases and it seems ‘telehealth’ technology may provide one such solution.


A


recent study funded by the Health Research Board revealed that patient self-testing of Warfarin therapy, using an internet-based ‘expert system’, is more effective than the time-consuming conventional approach in the clinic. Fiona Ryan, School of Pharmacy, University College, Cork, who completed the study, explains. Warfarin treatment is prescribed to manage a variety of illnesses associated with the ability of the blood to clot. Some people find their blood clots too


easily, causing conditions such as deep vein thrombosis. For others, their blood may be at an increased risk of clotting due to an irregular heartbeat e.g. Atrial Fibrillation. Conditions such as these require preventative treatment with blood-thinners. In many cases, this is achieved using oral anticoagulant therapy (oAT), such as warfarin, and by measuring the length of time it takes for their blood to clot, using a test called the International normalised Ratio (InR). In Ireland, most patients have to go to a hospital-based clinic, or to their GP to have their INR performed. This is time consuming for staff in the clinics and requires regular hospital visits for patients. With current demand for OAT expected to increase six-fold by 2050, great pressure will be felt in OAT clinics if an alternative approach is not identified.


+ Research team – Susan o Shea, Cork university Hospital, Fiona Ryan and Stephen Byrne, university College Cork.


We conducted the first ever randomised control trial of an internet-based, direct-to- patient expert system that enabled remote and effective management of Warfarin therapy. Over the course of nine months, 132 patients were recruited to our trial. They tested their blood (InR) at home using a portable meter, and entered this result along with other personal details onto the web page. They received instant feedback from the system, which described what dose of Warfarin they should take and when they should do their next blood test. Patients also visited the anticoagulation clinic every eight weeks to have their therapy reviewed, instead of approximately every three to four weeks in the routine care group. Our randomised controlled trial proved extremely successful on a number of levels. • Patients reported a higher percentage of blood tests within their desired recommended range (X per cent versus y per cent), compared with patients who had their blood tests performed in the clinic in the usual manner


• The amount of patients attending the hospital-based clinic was reduced, which reduced pressure on clinic staff and patients


• Patients were able to perform their blood tests while travelling abroad


According to the patient satisfaction survey:


• 99.1 per cent said they found the equipment easy to use • 94.7 per cent said they felt their InR was more effectively controlled, compared to while attending the clinic • 98.3 per cent preferred patient self-testing compared to attending the hospital-based clinic. This is a strong conclusion in support of using internet-based direct-to-patient expert system to manage Warfarin therapy. The next step is to work towards it being implemented nationally in practice effectively.


The results of this study have been published in the journal of Thrombosis and Haemostasis*. Fiona Ryan completed the study while working under the supervision of Stephen Byrne (Pharmaceutical Care Research Group, School of Pharmacy, University College Cork) in collaboration with Susan o' Shea (Haematology department in Cork university Hospital). * Ryan F, Byrne S, o’Shea S., Randomized controlled trial of supervised patient self- testing of Warfarin therapy using an internet- based expert system. j Thromb Haemost. 2009 Aug;7(8):1284-90.


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