Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes

Letters6 September 2011Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical OutcomesAndrea Siebenhofer, MD, Klaus Jeitler, MD, and Ivo Rakovac, PhDAndrea Siebenhofer, MDFrom Institute of General Practice, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria; and Institute for Biomedicine and Health Sciences, Joanneum Research, 8010 Graz, Austria.Search for more papers by this author, Klaus Jeitler, MDFrom Institute of General Practice, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria; and Institute for Biomedicine and Health Sciences, Joanneum Research, 8010 Graz, Austria.Search for more papers by this author, and Ivo Rakovac, PhDFrom Institute of General Practice, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria; and Institute for Biomedicine and Health Sciences, Joanneum Research, 8010 Graz, Austria.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-5-201109060-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We found the recent article by Bloomfield and colleagues (1) very interesting. Having recently conducted a trial on the same subject (2), we feel that some issues require further clarification.Because patient self-testing and self-management are very different, variations in the effectiveness of the 2 interventions deserve special attention. Self-testing enables patients only to monitor the international normalized ratio, whereas self-management empowers patients to take action in achieving better anticoagulation control. Figuratively speaking, self-testing, in contrast to self-management, is like being a passenger watching the speedometer instead of being in the driver's seat. It would therefore be ...References1. Bloomfield HE, Krause A, Greer N, Taylor BC, MacDonald R, Rutks I, et al. Meta-analysis: effect of patient self-testing and self-management of long-term anticoagulation on major clinical outcomes. Ann Intern Med. 2011;154:472-82. [PMID: 21464349] LinkGoogle Scholar2. Siebenhofer A, Rakovac I, Kleespies C, Piso B, Didjurgeit U; SPOG 60+ Study Group. Self-management of oral anticoagulation reduces major outcomes in the elderly. A randomized controlled trial. Thromb Haemost. 2008;100:1089-98. [PMID: 19132235] CrossrefMedlineGoogle Scholar3. Matchar DB, Jacobson A, Dolor R, Edson R, Uyeda L, Phibbs CS, et al; THINRS Executive Committee and Site Investigators. Effect of home testing of international normalized ratio on clinical events. N Engl J Med. 2010;363:1608-20. [PMID: 20961244] CrossrefMedlineGoogle Scholar4. Trivedi AN, Matula S, Miake-Lye I, Glassman PA, Shekelle P, Asch S. Systematic review: comparison of the quality of medical care in Veterans Affairs and non-Veterans Affairs settings. Med Care. 2011;49:76-88. [PMID: 20966778] CrossrefMedlineGoogle Scholar5. Asch SM, McGlynn EA, Hogan MM, Hayward RA, Shekelle P, Rubenstein L, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004;141:938-45. [PMID: 15611491] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Institute of General Practice, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria; and Institute for Biomedicine and Health Sciences, Joanneum Research, 8010 Graz, Austria.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample Steven M. Asch , Elizabeth A. McGlynn , Mary M. Hogan , Rodney A. Hayward , Paul Shekelle , Lisa Rubenstein , Joan Keesey , John Adams , and Eve A. Kerr Meta-analysis: Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes Hanna E. Bloomfield , Ange Krause , Nancy Greer , Brent C. Taylor , Roderick MacDonald , Indulis Rutks , Preetham Reddy , and Timothy J. Wilt Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes Hanna E. Bloomfield , Brent C. Taylor , and Timothy J. Wilt Metrics Cited ByPatient Self-Management of Oral Anticoagulation with Vitamin K Antagonists in Everyday Practice: Efficacy and Safety in a Nationwide Long-Term Prospective Cohort Study 6 September 2011Volume 155, Issue 5Page: 336KeywordsConflicts of interestElderlyHealth careHealth care qualityPatient advocacyStroke ePublished: 6 September 2011 Issue Published: 6 September 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...