Programme no. 251-P
Patient Empowerment
Chronic anticoagulation treatment: self-care and frequency of INR testing
Jaana Puhakka*1, Minna Kaila2, Irmeli Suvanto3, Janne Pitkäniemi4
1Social services and Health Care,City of Helsinki,Helsinki,Finland, 2Public Health,Helsinki University, School of Medicine,Helsinki,Finland, 3Social services and Health Care,City of Helsinki,Helsinki,Finland, 4Statistics,Cancer Registry,Helsnki,Finland
* = Presenting author
Objectives: Three different patient groups with warfarin treatment were established: physician instruction, nurse instruction and patient self-care. Allocation to the groups is based on risk assessment by physician, patient willingness and capability.

The intervention consisted of 1) information of self-care and of new methods of receiving dosing instructions (patients and professionals) 2) education and post testing knowledge (patients and professionals) 3) testing materials and tools for project. This is pragmatic development project was carried out in real-life setting with before and after measurements of change in average INR.

Background: The self- care and e-services of the anticoagulation project is carried out as part of the activities of the City of Helsinki Department of Social Services and Health Care. this organization is serving a population of approximately 596,000, and operating 25 health stations, with 329 physicians and 583 nurses. In 2012, there were 10 000 patients on warfarin treatment and 140 000 INR-tests were taken. The aim of the project was to implement self-care and resulting improvement of the patient care.

The number of patients on requiring treatment with warfarin has increased in recent years because of ageing of the population and wider indications for anticoagulation treatment. We estimated that 65 % of the INR test results are at target range (2.0 -3.0). Relaying on the patients themselves in the interpretation of the INR results and dosing takes more time and results in waste of time of the patient,-and nurse as well as-the physician. The frequency of INR- testing for patients annually has been higher than expected when compared with number of INR results with therapeutic range.

Results: No significant measurable increase in the frequency of laboratory tests was found.Standard deviation of Mean INR tests per patient 3,64 (3,65 ; 3,63 CI 95%)
Material/Methods: The frequency with which the patients visited the laboratory was calculated to ensure that patients were not overusing the laboratory when self assigning the control interval.

The study consisted of 2006 patients who received their INR values via a text message and were part of the self-care group. The time period studied ranged from January 2008 to June 2013. The values measured were the number of INR tests per quarter year, per the number of unique patients tested for INR during that time.

Conclusion: Patients were not overusing the laboratory when self assigning the control interval.
Points for discussion: Self-care for patients with chronic warfarin treatment can save resources and costs