Abstract P98: Patient Impressions and Cost-Savings Associated With Home-Based International Normalized Ratio Monitoring in a Prospective Clinical Trial

OBJECTIVE: The aim of this study was to evaluate patient impressions and cost-savings associated with home INR monitoring as compared to usual INR monitoring at a medical clinic. METHODS: This was a “before and after” study that was conducted in a local clinical research center. Patients were enrolled from twelve sites with a variety of indications for chronic oral anticoagulation. Patients began a program of INR self-testing and automated online management provided by one of the investigators (HIB). Patients completed a survey that asked for demographics, monitoring preference, miles driven, and time spent for monitoring; the Duke Anticoagulation Satisfaction Scale (DASS) was completed at baseline and follow-up. Only patients with baseline and follow-up surveys were included in the analysis. Chi-square was used to compare nominal variables. Responses from a five-item likert scale for monitoring preference, income, and amount willing-to-pay were dichotomized. Time spent, miles driven for monitoring, and DASS scores were compared using Wilcoxon signed-rank. RESULTS: Of the 44 patients who completed both surveys, most were male (24/44), married (33/44), Caucasian (36/44), and had finished at least some college (40/44). Nearly half were retired (21/43) and had an annual household income of at least $50,000 (21/44). Patients spent more time for clinic versus home monitoring (median, interquartile range): clinic 108 (60-150) min versus home 10 (7-15) min, p<0.0001. Home monitoring reduced miles driven by a median of 20 (10-50) miles. Almost all patients agreed or strongly agreed with the statement that “home INR monitoring is preferable to clinic monitoring” (38/42). Most patients reported that they would pay for home monitoring to eliminate one clinic visit (28/37). Income greater than $50,000 was associated with an amount willing-to-pay greater than $25 (p=0.02). Overall satisfaction (p=0.007) and patient recommendation of anticoagulation management (p<0.0001) improved at follow-up compared to baseline. Perceptions of monitoring difficulty (p=0.04), complexity (p=0.03), and inconvenience (p=0.02) all decreased. CONCLUSION: Home INR monitoring is preferred by patients and saves time and money compared to clinic monitoring.