Kid Clot Thrombosis Program



Evaluation of a Unique mHealth Web-Based VKA Management SystemAuthors: Bauman, Seniuk, Siddons, Bruce, MassicotteBauman corresponding Mobile health (mHealth), supported by international health governing bodies, is a growing field that uses web based and mobile communication devices to improve health outcomes, healthcare services and health research, and may be used as a tool for reporting INR results.Patients prescribed long term vitamin K antagonist (VKA) therapy require close monitoring of their INRs. INR results are received by the patient directly from the laboratory or by self-testing using home INR meters and then are reported to the health provider for dose adjustment.Aim: This study is to evaluate functionality and patient satisfaction with use of the INR reporting website .Methods: The KIDCLOT? website was established as a tool for INR reporting using an SSL address. Two groups of patients prescribed VKA therapy used this website: 1) patients who self-managed (PSM) their VKA therapy and 2) patients who self tested (PST) INRs with the KIDCLOT? health provider adjusting their VKA dose. Patients entered INR results into the website via computer or smartphone. Each was assigned a secure ID and password to log into the site. Usernames are only identifiable to the KIDCLOT? clinical team with no other patient identifiers stored in the database. Patient and administrative staff have different levels of access; therefore no patient has access to data outside of their own profile. This security is consistent with international health privacy policies. All patients enter their INR result and VKA dose. PSM patients enter their INR, VKA dose adjustment, next INR testing date and comments. Whereas, PST patients enter their INR which triggers an email to the KIDCLOT health provider to provide the VKA dose adjustment and next INR testing date. The KIDCLOT? health provider enters the dose plan which alerts the patient. All patients receive an INR test reminder alert the day the INR is due. When reported INRs are outside of the patient’s therapeutic range an alert is sent to the KIDCLOT? health provider alerting the provider to review patient decision making, and allow immediate dosing support. Patient satisfaction surveys were completed by patients. Informed consent and ethics approval were obtained. Results: 33 of 51 website users responded to the satisfaction survey. Results from the patient satisfaction survey found that 100% of respondents “liked” the website format, found it easy to use, convenient, and preferred the website to any other method of INR reporting. 95% of patients reported that it assisted them to better manage their warfarin through INR alerts and ease of reporting. Patients reported the website to be a ‘great improvement’ ‘the best thing ever’ and ‘outstanding’ for INR reporting. Patients valued the ability to enter personal notes, and resource materials available on the website, and continued to feel supported by the KIDCLOT health care team. The KIDCLOT? health providers found the website to be an effective and efficient method for monitoring VKA therapy and for quality control for patients and health providers. Conclusion: INR reporting using mHealth is a valued solution for patients and health providers. ................
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