Microsoft word - inr pro self-testing patient checklist.doc

Should your patients be self-testing?
Patient Self-Testing Checklist
There are numerous publications showing the benefits of patient self-testing (accurate readings, reduction in major bleedings and strokes for patients, higher percentage of compliance, higher therapeutic time in range). Therefore, we will assume you don’t need convincing that it is a good thing. This document will focus on providing you with guidelines and recommendations for identifying patients who might be good candidates for self-testing. Clinic or physician’s office supports self-testing4, typically through documentation,
Patient is scheduled to take Coumadin/warfarin long term2
Patient can follow doctor’s orders and dosing instructions, and would agree to
Patient takes other medications with Coumadin/warfarin3
Patient is physically and mentally able to self-test2,3,4, which entails taking a drop of
blood from a finger prick, and using the home monitoring equipment, which requires manual and visual dexterity. If they have a caregiver that can perform the task, that is acceptable. Detailed training on instrument use is provided to each patient, but they must be able to remember the training, dosing instructions and the frequency of testing required. Patient expresses interest in having greater control or flexibility over their testing
and care2,3,4. It is often stated that the patient should be the one inquiring about a better
method for testing (tired of traveling to clinic or lab, require frequent testing, live far
away, or travel out of town frequently2) or expressing a need for better control over their
therapy (testing more frequently, wanting more reassurance between tests, dislike or have
trouble with venous blood draws, etc) before they should be considered for self-testing.
This would assure that the patient is committed to undertaking this activity, versus being
told to start self-testing. Certain patients who meet many of these criteria should be
notified about self-testing4, but ultimately they need to be committed to doing it.
Patient has at least 3 months of visits in lab or clinic setting to show ability to stay
within therapeutic range1,3,4. Since this seems a little vague, we would recommend that
you provide specific guidelines in your procedures for how you define “ability to stay
within therapeutic range” so you can develop a standard protocol. Medicare requires at
least 90 days of use, so we recommend using that as a minimum. Studies have also shown
that some patients improve their compliance when they begin self-testing, so this should
not be a disqualifier if they do not meet the guidelines you establish. You may even
identify patients who have trouble getting stable and consistent results as candidates, if
they meet many of the other criteria.
Patient has knowledge of Coumadin/warfarin, how it works, what impacts their
readings, and why it impacts them1. We recommend developing a quiz or list of questions to ask the patient, and providing them with some material. You can use the videos and training materials developed by AHRQ as a starting point. Patient self-testing is covered by insurance, or the costs will be covered or reimbursed
by some other method1,3. Generally, if the patient has the following diagnosis, they have a good chance of being covered by their insurance provider2: o Chronic atrial fibrillation o Mechanical heart valve o Hypercoagulable state o Venous thromboembolism (VTE) including, Deep Vein Thrombosis (DVT) Pulmonary embolism (PE) If insurance will not cover self-testing or certain conditions, some patients may be willing to help cover some or all of the costs themselves, in order to realize the benefits and freedom that it provides. Clinic/physician has the ability to easily communicate and stay in touch with
patient1,4. There should be an agreed upon method of communication for self-testing
patients established ahead of time. If a patient is hard to get a hold of, does not return
calls, or has trouble communicating in general, they may not be a good candidate.

After accessing each patient against the criteria listed above, it is important to document the
reason why the patient was approved or unapproved for self-testing. It is also recommended that
your office or clinic develop procedures and/or guidelines on how best to assess and manage
eligible patients.
References

1 Patient Self-Testing, Dr. Mark Wurster, Ohio State University Internal Medicine, presented at 7th Annual SECAPS
Anticoagulation Conference, Franklin, TN
2 Koninklijke Philips Electronics, “Is PT/INR Self Testing Right for You?”,
http://www.inrselftest.com/content/patients/quiz
3 “Improving your Warfarin Therapy”, Quality Assured Services, http://www.protimetest.com/improve.asp
4 “INR Self Testing for Coumadin Patients”, Stephan Moll, MD; University of North Carolina, Chapel Hill, NC Jack
Ansell, MD; Boston University Medical Center; Boston, MA, Published by National Alliance for Thrombosis &
Thrombophilia, http://www.stoptheclot.org/News/article120.htm
This checklist was compiled and developed by Healthcare System Solutions, developers of INR Pro, a web-based patient management system. Patient Self-Testing Checklist
Patient ame/ umber: _____________________________________________________

Clinic or physician’s office supports self-testing
____________________________________________________________________________________________________________________________________________________________________________ Patient is scheduled to take Coumadin/warfarin long term
____________________________________________________________________________________________________________________________________________________________________________ Patient can follow doctor’s orders and dosing instructions, and would agree to
perform weekly testing
______________________________________________________________________________________
______________________________________________________________________________________
Patient takes other medications with Coumadin/warfarin
____________________________________________________________________________________________________________________________________________________________________________ Patient is physically and mentally able to self-test
____________________________________________________________________________________________________________________________________________________________________________ Patient expresses interest in having greater control or flexibility over their testing
and care
______________________________________________________________________________________
______________________________________________________________________________________
Patient has at least 3 months of visits in lab or clinic setting to show ability to stay
within therapeutic range
______________________________________________________________________________________
______________________________________________________________________________________
Patient has knowledge of Coumadin/warfarin, how it works, what impacts their
readings, and why it impacts them
______________________________________________________________________________________
______________________________________________________________________________________
Patient self-testing is covered by insurance or by patient
____________________________________________________________________________________________________________________________________________________________________________ Clinic/physician has the ability to easily communicate and stay in touch with patient
________________________________________________________________________________________________________________________________________________
Final Comments/ otes:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Evaluation Performed by: _______________________ Date Completed: ___________

Source: http://www.inrpro.com/Self_Testing_Checklist.pdf