Evaluation of a clinical pathway to enable patient self-monitoring of anticoagulation

Aim: Previous studies suggest that self-monitoring (PSM) of the international normalised ratio (INR) may improve the outcomes of oral anticoagulation therapy through increasing the time spent within the target range (TTR), and improving both consumer satisfaction and participation in healthcare. The purpose of this study was to develop, implement and evaluate a pathway to enable people talking warfarin to monitor their own therapy in the community setting. Method: A structured training program was developed to facilitate the transition of consumers from usual care to PSM using the existing Home Medicines Review (HMR) model. Consumers were recruited through their community pharmacies and, in collaboration with their general practitioners, received intensive one-on-one warfarin education and training in using the CoaguChek XS point of care INR monitor by a trained HMR accredited pharmacist. PSM was undertaken for six months. Outcome measures included TTR, quality of life, warfarin knowledge, and consumer satisfaction. Result: Twenty-eight patients with a minimum six-month history of anticoagulant treatment were recruited from Tasmania and New South Wales. Sixteen (57.1%) were male and 64.3% required anticoagulation for atrial fibrillation. At baseline, the mean TTR was 64.8%. The mean baseline warfarin knowledge score was 72.4% using a validated warfarin knowledge questionnaire. Qualitative feedback from consumers and general practitioners has indicated a high level of satisfaction with both the training program and PSM. Qualitative and quantitative results after six months of PSM will be reported. Conclusion: Using the proposed model, trained pharmacists successfully identified and trained suitable consumers to undertake PSM. Initial qualitative feedback has been positive. Future investigation of both qualitative and quantitative data will aim to provide objective data to support these positive findings. This shared model could be used to identify suitable candidates for PSM and provide Australians with access to appropriate training and support.