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Self-monitoring and self-management of oral anticoagulation therapy

Finland Distance monitoring
Oral anticoagulant treatment requires regular laboratory testing of INR. This digital solution improves anticoagulation treatment by enabling self-monitoring of INR (international normalized ratio) and self-management of oral anticoagulation therapy. The solution consists of a device to measure and a web-based service to relay results on your smart phone. The measurement result is immediately available to you and your health care professional, so you can easily make changes to your medication.
The service gives the patient the freedom to measure INR when it is best for him / her and change the medication based on instructions from doctors. Laboratory visits are reduced, resulting in reduced costs and time for both patients and professionals. The quality of oral anticoagulant therapy are improved (international studies). The solution increase self-monitoring and self-medication and improves quality of life.
All citizens who have to measure their INR-value. In city of Oulu there are about 60 patients using this solution and the service is expanding in the near future.
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Quotes/testimonials

“Saves time. No need to adjust working hours due to laboratory visits. It is a big thing that you can do the measurement easily and the result is available immediately. I can be confident about the treatment.”

—Patient

Elaboration

Needs and challenges

Oral anticoagulant treatment requires regular laboratory testing of INR. If treatment level is good, laboratory testing takes place every 4 to 6 weeks, if balance is poor, patient needs to go to laboratory every few days. In northern Finland, distances are long and traveling to the laboratory takes a lot of time for the patients.

INR measurement and managing anticoagulant treatment needs personel from laboratory and health care center. When the patient arrives to the laboratory, he/she has to wait, as a professional checks the value and later inform the patient what to do and prescribes the medicine.

Solution and function

The solution consists of a device to measure and a web-based service to present results on your smart phone. The patient takes a blood sample from the fingertip, the device measures and displays the reading. Patient receives instructions on what to do based on the value.

The measurement result is immediately available to you and your health care professional, so you can easily make changes to your medication.

The solution is easy to use. All the readings are stored in the cloud service, from which they can be viewed by the patient throughout the measurement period.

Implementation

The solution is quite easy to implement. Implementing requires new thinking from both professionals and patients.

Professionals need to evaluate treatment process with digital tool and change their role to more coach-like. Blood samples quality has to be good, so the patients need to be taught how to take a sample in the right way. 

Economy

Patient needs to have a smart phone of his own. A municipality gives device and medical supplies to the customer.

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Process

The healthcare sector must make a decision of the use of remote technology with the patients with warfarin. The professionals need to be trained in remote technology solutions.

The nurse guides the patient how to take a blood sample and how to use the device, and gives instructions to the patient how take the medicine. 

Customer has to go twice a year to the laboratory and give venous blood and on the same day, the sample is taken from fingertip. 

Professionals also must educate patients to self-monitoring and even more so, self-managing the medication. After training professionals must trust adjustment of medication to patient’s hands (with observation). 

Organisation and politics

Public funding is needed for remote technology services. Increasing self-care and cost allocation for the persons who need this the most.

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Follow-up/monitoring

Follow-up and monitoring should be done regarding anticoagulant treatment quality improvement, treatment balance better (TTR), patient and professional satisfaction.

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More about effects

The solution entails independence; The Patient can measure him-/herself, doesn't need to go to the laboratory, and learns to understand how much medicine to take.

  • The responsibility is transfered from the professional to the patient.
  • The solution results in less visits/contacts to professionals, which reduces costs.

Learnings

  • Patients has to know how to use a smartphone, software upgrade must be done if needed  
  • Patient has to learn how to take a blood sample from a fingertip to get a sufficiently large drop
  • Patients results goes to a web-based database, not directly to medical records. Results has to be transformed by professional to medical record. Interface might be possible to make.
  • Self-managing requires training by professionals. 

 

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The model can be used for patients with warfarin and want to measure and define their medication.

Eila Erkkilä: Eila.Erkkila@ouka.fi 

Minna Tolonen: Minna.Tolonen@ouka.fi 

Improving anticoagulant treatment 

Elisa Appelsiini 

www.elisa.fi