Managed Care - October 2008 - (Page OA6) TABLE 3 Options for patient self-testing (PST) communications Communication system Dedicated auto-answer line or voice response answering line E-mail or fax; electronic uploading of results Possible patient advantages Simple, easily accessed May be preferred for patients with speech or hearing impairments Possible practitioner advantages Results can be promptly accessed throughout the day without interrupting patient care Written copy of communication can be added to the record Results transmitted to practitioner’s designated system in real time; may facilitate ease of practitioner review process Third-party management service Simple, easily accessed; toll-free number phone calls while still receiving INR results promptly and reliably. Patients may be instructed to call the office with out-of-range results (may be specifically predetermined by the practitioner) so they can be managed appropriately in those situations. Practitioners should ensure the method they select is HIPAA-compliant. Table 3 outlines some advantages for different PST communication options. Accuracy of INR devices The ease of use and portability of whole-blood INR devices has made home testing by patients or their caregivers a feasible option for monitoring warfarin therapy, and home testing has been demonstrated to result in increased time in therapeutic range; improved outcomes, including lower rates of thrombotic and bleeding complications; and increased survival relative to usual care TABLE 4 Profile of CLIA-waived INR instruments for patient self-testing (PST) INRatio (HemoSense Inc.) INR range Sample ISI Clot detection principle Analysis time Correlation coefficient QC Memory 0.7–7.5 1 drop capillary blood 1.00 Change in impedance 1–1.5 min. 0.96 Internal 60 tests ProTime (ITC) 0.8–9.9 1 drop capillary blood 1.00 Cessation of blood flow 3–5 min. 0.95 Internal 50 tests CoaguChek XS (Roche Diagnostics) 0.6–8.0 1 drop capillary blood 1.00 Icon-based LCD and amperometric PT determination 1 min. 0.96 Internal 100 tests CLIA=Clinical Laboratory Improvement Act, INR=international normalized ratio, ISI=international sensitivity index, LCD=PT=prothrombin time, QC=quality control. 6 MANAGED CARE / SUPPLEMENT
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