in older patients poses unique challenges because they are simultaneously at higher risk for recurrent thromboembolism and major bleeding, including catastrophic intracranial haemorrhage.[6-8] Older patients may be at increased risk for anticoagulant-related bleeding because of the increased prevalence of comorbidity and polypharmacy, increased vascular click here and endothelial fragility, dietary inadequacies and increased sensitivity to warfarin.[9, 10] The limitations of warfarin necessitate regular monitoring of the International Normalised Ratio (INR) and dose adjustment. The efficacy and safety of warfarin therapy is strongly linked to the proportion of time that patients spend in the target INR range (time in therapeutic range; TTR).[11, 12] Unfortunately, many patients who are prescribed warfarin and managed in community settings, including those residing in aged-care facilities (ACFs), spend a considerable proportion of their time outside of the therapeutic range.[2, 13, 14] Barriers to optimal INR control in ACFs may include
difficulties arranging for pathology providers to visit the ACF, the time taken for the general practitioner (GP) to be notified of the INR result and the time taken for the GP to adjust the warfarin dose, if required, and alert or visit the ACF to implement changes. Point-of-care (POC) coagulometers, Ibrutinib purchase which measure the prothrombin time from capillary whole blood and provide an INR reading within minutes, are becoming increasingly popular. They can be used by patients to enable self-monitoring of
warfarin and in primary care settings as an alternative to traditional laboratory determination of the INR. Use of such devices can benefit both patients and primary care physicians in managing anticoagulation therapy.[16, 17] The combination http://www.selleck.co.jp/products/erastin.html of POC monitoring and telemedicine may assist in improving access to regular INR monitoring and the communication of results in primary care. The use of telemedicine systems provides an opportunity to reduce labour-intensiveness and improve clinical outcomes for chronic diseases. The aim of this study was to develop and fully evaluate a pilot system that integrated monitoring of clinical parameters or therapeutic outcomes, using portable POC testing devices, with electronic communication of the results from ACFs to GPs and electronic feedback from GPs to the ACFs, utilising national information communication technology (ICT) standards. We conducted a prospective before-and-after proof-of-concept study to compare the INR control achieved with POC INR monitoring and electronic communication to and from GPs with the control achieved in the 12 months immediately preceding the study using conventional management (laboratory INR with physician dose adjustment).