Van Beek Andrea, Bowers Margaret, Hall Bruce, Meyer Barry
Duke University, Visalia Medical Clinic, Visalia, California.
Duke University School of Nursing, Durham, North Carolina.
J Am Assoc Nurse Pract. 2019 Nov 21;33(7):563-569. doi: 10.1097/JXX.0000000000000339.
Patients who take warfarin require frequent testing of their international normalized ratio (INR) level to ensure accurate dosage. Frequent testing can be inconvenient for patients in rural settings, the workforce, the homebound, or those who travel. Patients who have a home INR monitor can test their blood remotely.
To circumvent barriers to INR testing, a quality improvement project was designed to implement home INR testing in an anticoagulation clinic setting.
Patients who received a home INR monitor were compared against two usual care testing arms (laboratory and clinic testing patients) in the outcomes of time in therapeutic range (TTR), adverse events, and patient satisfaction using the Duke Anticoagulation Satisfaction Scale (DASS).
The DASS survey demonstrated the home testing patients had a statistically significant advantage over the clinic testing group in the subdomain of hassles and burdens (p = .048), as well as the lowest overall scores (indicating highest satisfaction) over the clinic testing group (p = .041). No patients in the home testing group had clotting or bleeding issues necessitating hospital admission. There were no significant differences between groups in the TTR analysis (laboratory 70.8%, home 68.9%, and clinic 64.5%) (p = .683).
Home INR testing provides convenience for patients and reduces the hassles and burdens of warfarin management, leading to improved satisfaction. This engagement in self-care translates to reduced adverse events. Home INR testing can be used in warfarin patients who are highly motivated and willing to engage in their care.
服用华法林的患者需要频繁检测其国际标准化比值（INR）水平，以确保剂量准确。频繁检测对于农村地区患者、劳动力人群、居家患者或旅行者来说可能不太方便。拥有家用INR监测仪的患者可以远程检测血液。
为克服INR检测的障碍，设计了一个质量改进项目，以在抗凝门诊环境中实施家用INR检测。
将接受家用INR监测仪的患者与两个常规护理检测组（实验室检测患者和门诊检测患者）在治疗范围内的时间（TTR）、不良事件和使用杜克抗凝满意度量表（DASS）的患者满意度结果方面进行比较。
DASS调查显示，在家检测的患者在麻烦和负担子领域比门诊检测组具有统计学上的显著优势（p = 0.048），并且在总体得分上比门诊检测组最低（表明满意度最高）（p = 0.041）。在家检测组中没有患者出现需要住院治疗的凝血或出血问题。TTR分析中各组之间没有显著差异（实验室70.8%，在家68.9%，门诊64.5%）（p = 0.683）。
家用INR检测为患者提供了便利，减少了华法林管理的麻烦和负担，提高了满意度。这种自我护理的参与转化为不良事件的减少。家用INR检测可用于积极性高且愿意参与自身护理的华法林患者。
