Managed Care - October 2008 - (Page OA1) SUPPLEMENT TO Care October 2008 M A N A G E D Oral Anticoagulation Patient Self-Testing: Consensus Guidelines for Practical Implementation Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Challenges of managing patients on warfarin therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Patient self-testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Need for oral anticoagulation therapy expected to increase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Rationale for wider implementation of PST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Comparative studies of PST and PSM as an adjuvant to usual care . . . . . . . . . . . . . . . . . . . . . . . 3 PST costs and related reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Practitioner options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Cost-effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Practical guidelines for implementation of PST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Patient selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Communication between practitioners and patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Accuracy of INR devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Ongoing follow-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Summary of consensus panel recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 A call to action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 This supplement is sponsored by Inverness Medical. The material in this supplement has been independently peer reviewed. The grantor played no role in reviewer selection. Opinions are those of the authors and do not necessarily reflect those of the institutions that employ them, or of Inverness Medical; MediMedia USA; or the publisher, editor, or editorial board of MANAGED CARE. Clinical judgment must guide each clinician in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this supplement may reflect the clinical experience of the authors or may reflect the professional literature or other clinical sources and may not be the same as indicated on the approved package insert. Please consult the complete prescribing information on any products mentioned in this publication. MediMedia USA assumes no liability for the material published herein.
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