Effect of a combined education and eHealth programme on the control of oral anticoagulation patients (PORTALS study): a parallel cohort design in Dutch primary care

Abstract

ObjectivesTo analyse the effect on therapeutic control and self-management skills of the implementation of self-management programmes, including eHealth by e-learning versus group training.SettingPrimary Care Thrombosis Service Center.ParticipantsOf the 247 oral anticoagulation therapy (OAT) patients, 63 started self-management by e-learning, 74 self-management by group training and 110 received usual care.Intervention and methodsParallel cohort design with two randomised self-management groups (e-learning and group training) and a group receiving usual care. The effect of implementation of self-management on time in therapeutic range (TTR) was analysed with multilevel linear regression modelling. Usage of a supporting eHealth platform and the impact on self-efficacy (Generalised Self-Efficacy Scale (GSES)) and education level were analysed with linear regression analysis. After intervention, TTR was measured in three time periods of 6 months.Main outcome measures(1) TTR, severe complications,(2) usage of an eHealth platform,(3) GSES, education level.ResultsAnalysis showed no significant differences in TTR between the three time periods (p=0.520), the three groups (p=0.460) or the groups over time (p=0.263). Comparison of e-learning and group training showed no significant differences in TTR between the time periods (p=0.614), the groups (p=0.460) or the groups over time (p=0.263). No association was found between GSES and TTR (p=0.717) or education level and TTR (p=0.107). No significant difference was found between the self-management groups in usage of the platform (0–6 months p=0.571; 6–12 months p=0.866; 12–18 months p=0.260). The percentage of complications was low in all groups (3.2%; 1.4%; 0%).ConclusionsNo differences were found between OAT patients trained by e-learning or by a group course regarding therapeutic control (TTR) and usage of a supporting eHealth platform. The TTR was similar in self-management and regular care patients. With adequate e-learning or group training, self-management seems safe and reliable for a selected proportion of motivated vitamin K antagonist patients.Trial registration numberNTR3947.

Self-care training and informational support of patients with a mechanical heart valve on the international normalized ratio and bleeding complications

“…It has been found that several factors such as socioeconomic factors, diet, concomitant medication, underlying disease, knowledge, activity, etc. affect the effects of warfarin and the occurrence of side effects in consumers [13][14][15]. Accordingly, heart valve replacement patients need to be sufficiently aware of the factors that can affect the individual and take care of themselves against the influential factors.…”

A Systematic Review on Mobile Health Applications’ Education Program for Patients Taking Oral Anticoagulants

“…A high-quality cohort design was not pursued because participant enrollment and exogenous variables could not be controlled. Furthermore, rather than improving self-management through education, the measurement index focused on clinical indicators such as INR values and complications [4,26,34]. It can be seen that the program was applied using the mHealth application, even though the quality is not high.…”

“…In contrast, the Oral Anticoagulation Knowledge (OAK) tool was used in two studies [30,32]. Two studies confirmed efficacy as an outcome, and the assessment tools were different [26,34]. Three papers reported QOL (i.e., HRQoL with the Atrial Fibrillation Effect on Quality of Life (AFEQT), and Patient Health Questionnaire (PHQ-9)) [33,35].…”

Combining portable coagulometers with the Internet: A new model of warfarin anticoagulation in patients following mechanical heart valve replacement

“…Additionally, effective patient education has influenced warfarin treatment of valvular heart disease ( 52 ). In addition to designing the doctor-patient communication website, other researchers ( 53 ) have developed Internet courses to help educate patients about the importance of adhering to a medication regimen, thereby improving their health and reducing thromboembolic events and hospitalizations. With the rapid development of mobile Internet in this century, online management based on websites and e-mail has gradually turned to mobile phones and other mobile terminals, providing additional options for remote warfarin management.…”