Sociotechnical design for mobile anticoagulant therapy

In this paper we present MANTRA (Mobile ANticoagulant TheRApy), a project aimed at studying feasibility and acceptability of the introduction of mobile technology in the management of anticoagulant therapy involving both patients and health practitioners in their design. By the evaluation of the MANTRA Project, we developed a general approach to mHealth in the remote management of chronic diseases by supporting the communication among patients and healthcare practitioners. Patients usually have to make frequent visits to surgeries to meet nurses for the tests, and General Practitioners (GPs) for receiving drug prescriptions. We report on the implementation of the project as a proof of concept in London. A group of patients, General Practitioners, nurses, and healthcare assistants from the National Health Service (NHS) participated in design and evaluation phases. The distinct characteristics of the NHS as one of the world’s largest publicly funded health services posed a number of sociotechnical challenges to the design team. We present how we approached and addressed these challenges through MANTRA. Patients and Healthcare practitioners recognized the validity of our proposed design approach not only for supporting the remote therapy practice preserving an efficient and effective communication with the patients, but also as a way for better managing resources in anticoagulant clinics in the context of the NHS. With our research we explored the process that needs to be followed to develop a mobile system that would fit the sociotechnical ecosystem of anticoagulant therapy. Furthermore, we are now able to identify the changes that will be necessary in the ecosystem itself to make an effective use of the mobile system.