Patient self-management of oral anticoagulant care vs. management by specialized anticoagulation clinics: positive effects on quality of life

Abstract

Background: Oral anticoagulant therapy (OAT) implies frequent blood checks and dose changes to prevent thromboembolic or hemorrhagic complications. This may interfere with patients' social and working circumstances in addition to the possible stress caused by the condition necessitating this treatment. We studied whether patient self-management could be a way to improve quality of life in these patients.

Methods: Within a multicenter randomized study performed by two Dutch anticoagulation clinics, designed to study the effect on treatment quality (time within target range) of different modalities of patient self-management, we looked at the effect of increased patient education (n = 28), self-monitoring of the International Normalized Ratio (INR) (n = 47) and full patient self-management (INR monitoring and dosing of the OAT) (n = 41) on the quality of life of the patients. This was done with the aid of a written questionnaire (32 questions, minimum score = 1, maximum score = 6) at baseline (n = 163), and after 26 weeks (n = 118). We compared the results after 26 weeks with those at baseline, as well as between groups.

Results: General treatment satisfaction was already high under routine care (5.11 on a scale of 1-6) and increased further through self-monitoring of the INR (+0.19) and full self-management (+0.32). Distress (-0.44), perceived daily hassles (-0.31) and strain on the social network (-0.21) were reduced through full self-management. Improved patient education was associated with increased distress (+0.33) and perceived daily hassles (+0.23). Comparison at 26 weeks between groups showed similar improvements on these outcomes for self-monitoring and self-management vs. routine care after education.