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. 2023 Feb 3;7(2):100066.
doi: 10.1016/j.rpth.2023.100066. eCollection 2023 Feb.

Using an electronic medical record patient portal for warfarin self-management: Empowering children and parents

Sophie Jones  1   2   3 , Jodi L Hislop  2 , Hollie Gilmore  3 , Anthea Greenway  2   3 , James Hibbard  4 , Paul Monagle  2   3   5   6 , Fiona Newall  1   2   3   6   7
Affiliations

Using an electronic medical record patient portal for warfarin self-management: Empowering children and parents

Sophie Jones et al. Res Pract Thromb Haemost. .

Abstract

Background: Many children taking warfarin perform their international normalized ratio (INR) at home, with results phoned to a clinician who instructs warfarin dosing. Data suggest that parents can be supported to make warfarin dosing decisions themselves, a process known as patient self-management (PSM).

Objectives: This study aimed to determine the suitability and acceptability of warfarin PSM in children using the Epic Patient Portal.

Methods: Children currently performing INR patient self-testing were eligible. Participation involved an individualized education session, adherence to the PSM program, and participation in phone interviews. Clinical outcomes (INR time in therapeutic range and safety outcomes), patient portal functionality, and family experience were assessed. The hospital human research ethics committee approved the study and consent was obtained from parents/guardians.

Results: Twenty-four families undertook PSM. The median age of children was 11 years and all children had congenital heart disease. A median of 13 INRs was uploaded to the portal per family (range, 8-47) across a 10-month period. Before PSM, the mean time the INR was in therapeutic range was 71%; this increased to 79.9% during PSM (difference: P < .001). No adverse events were encountered. Eight families participated in a phone interview. The major theme identified was empowerment; minor themes that emerged included "gaining knowledge," "trust and responsibility builds confidence," "saving time," and "resources as a safety net."

Conclusion: This study demonstrates that communication via the Epic Patient Portal is satisfactory to families and offers a suitable option for PSM for children. Importantly, PSM empowers and builds confidence in families to facilitate management of their child's health.

Keywords: anticoagulants; child; electronic medical record; patient portals; self-management; warfarin.

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Figures

Figure
Figure
Theme of empowerment and the sub-themes that contribute to feelings on empowerment in children and parents on warfarin PSM program.
See this image and copyright information in PMC

References

    1. Monagle P., Cuello C.A., Augustine C., Bonduel M., Brandão L.R., Capman T., et al. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv. 2018;2:3292–3316. - PMC - PubMed
    1. Mahle W.T., Simpson S.A., Fye P., McConnell M.E. Management of warfarin in children with heart disease. Pediatr Cardiol. 2011;32:1115–1119. - PubMed
    1. Monagle P. Anticoagulation in the young. Heart. 2004;90:808–812. - PMC - PubMed
    1. Bauman M.E., Black K.L., Massicotte M.P., Bauman M.L., Kuhle S., Howlett-Clyne S., et al. Accuracy of the CoaguChek XS for point-of-care international normalized ratio (INR) measurement in children requiring warfarin. Throm Haem. 2008;99:1097–1103. - PubMed
    1. Bauman M.E., Bruce A., Jones S., Newall F., Massicotte M.P., Monagle P. Recommendations for point-of-care home international normalized ratio testing in children on vitamin K antagonist therapy. J Thromb Haemost. 2013;11:366–368. - PubMed

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