"most patients not good candidates .........

shop deals on amazon
Shop deals on ebay
Advertise with us
Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
L

lance

Well-known member
Joined
Nov 3, 2003
Messages
1,357
Location
Ontario
Part of a paragraph appearing in the Conclusions section on POC home monitoring reads in part "most patients not good candidates for self testing and self management.

The paper "Safety and effectiveness of point of care monitoring devices in patients on oral anticoagulation therapy: a meta analysis" published in Open Medicine Vol. 1 No. 3 (2007). authored by Wells, P. et. al. This link was recently posted in the thread with several ????????????? in the title.

I can't remember the exact words but the authors feel POC monitoring is not suitable for widespread use at this time.

Some find the cost prohibitive and other than that can't think of one reason for Dr. Wells conclusions.

Any ideas?
 
I don't know. Is there some kind of a lab union they don't want to mess with?
 
Surprisingly, there are ACT patients who still think that this is all "rocket science".
They have no desire to shoulder the responsibility of accurately testing and reporting to their doctor, let alone deciding on dosages.
 
At this time..I would trust myself over my PCP...she is worthless,the only
reason I see her is for lab work,prescriptions and referrals.
I guess most patients either don't have a doc like mine, or they aren't
interested in educating themselves.
Don't mean to sound harsh,but I had a bad experience with my PCP
recently...can you tell?:D
 
Well, I have always felt that home testing is for those who want to. Naturally, trying to push it on those who are afraid or just don't want to isn't going to work well.

Of course, I would want to.

There is always some self-proclaimed expert who wishes to exalt himself by proclaiming the rest of the world incompetent to do what he feels he can do. Prior generations revered these people and bestowed upon them the honored title of "Pompous Ass."

Here's hoping that those who would deny people their power over themselves and their ability to control their own destinies will move aside (or be moved aside) as experience shows that people who self-test have more even anticoagulation, with fewer expensive bleeds, strokes, and emergency room visits. That's what will wake up the insurance companies. Cha-ching!

Best wishes,
 
Lance:

I read through the pdf file and was curious about the authors. None appears to be a cardiologist or hematologist -- mostly researchers or someone connected with some aspect of the economics of health care (Canadian system).

It did appear to indicate that people who did home-testing and self-adjusted doses had better training on such and anticoagulation therapy in general than others who take warfarin and go to a lab for tests.

It indicated a reluctance to prescribe home-testing for most people because it would mean that some people would not be seen as frequently by their doctors. (Hmmmmmmmmm. Can you say loss of revenue?)
 
Catwoman,
P. Wells works at the Ottawa General Hospital in Hematology.:eek: I offered via e-mail--it hasn't been read let alone responded to--to introduce him to about 200 people successfully dosing and testing themselves.

Cocoalab,
That must be it--union involvement.;) or shares in the company supplying chemicals for lab testing,:rolleyes:

Ross
If you mean what I think you mean they're spherical shaped, you know balls.:cool: I shovel them everyday and the roll even further now they are frozen.:eek: Some refer to them as road apples.:p

The real issue I have with that medical paper with about 50 references is it well-read in the medical community. This paper and probably others promotes the erroneous assumption that POC monitors are dangerous and inaccurate.:( This attitude puts patients in harms way.

I've e-mailed the hospital and Dr. Wells don't know what else can be done except keep my temper under control. In these circumstances--not easy.
 
:mad::mad:mad:

Do they know what they are saying???????

Didn't think so:p

zipper2 (DEB)
 
lance said:
I've e-mailed the hospital and Dr. Wells don't know what else can be done except keep my temper under control. In these circumstances--not easy.
Click to expand...

Send the Monkey Pus the link to this: Hell they even get credit for watching it!

To earn free CME credit for watching this program, you must complete the online CME test and evaluation. You must be registered and signed-in in order to take the test online. Upon successful completion of the test and the evaluation, you will be asked to select your professional category and will be able to print the appropriate credit certificate right from your computer. You must answer a minimum of 7 out of 10 questions correct in order to earn CME credit.



http://discoveryhealthcme.discovery.com/anticoagulation/anticoagulation.html
 
Doesn't everyone realize that those that take Coumadin are mentally challenged and diabetics are all geniuses. This is why diabetics are perfectly capable of managing (in my opinion) a much more dangerous health issue on their own through DAILY home testing and self-dosing and Coumadin users aren't capable of sticking their finger to get a drop of blood every week or 2.
 
I have read the paper and nowhere can I find any statement that says home monitors are inaccurate. On the contrary, the Abstract says "The use of POCDs is safe and may be more effective than laboratory-based monitoring." It also says "Data analysis showed that POCD INR testing reduced the risk of major thromboembolic events, was associated with fewer deaths, and resulted in better INR control compared with laboratory INR testing". The message I took from the paper is that POC home monitoring IS beneficial, however, more properly designed testing is required to determine why this is and certainly before implementing POCD as the definitive standard in OAT. Obviously there are strong opinions on this in the community, particularly on the ststement that "..most patients are not good candidates for self testing and self-management". If one looks at the entire set of people who may be on oral anticoagulation therapy, this could quite well be a true statement. The fact that there are 200 people that are doing it successfully is a rather small sample when there are millions of people out there on OAT! Rather than channel that strong feeling into negative energy against a guy who genuinely seems to be trying to get a definitive scientific answer to support POCD, I suggest that all 200+ of those people who are successfully home monitoring offer themselves for clinical study.
 
Karlynn said:
Doesn't everyone realize that those that take Coumadin are mentally challenged and diabetics are all geniuses. This is why diabetics are perfectly capable of managing (in my opinion) a much more dangerous health issue on their own through DAILY home testing and self-dosing and Coumadin users aren't capable of sticking their finger to get a drop of blood every week or 2.
Click to expand...

How true....imagine telling a diabetic that they are "not a good candidate" for home testing.:(
 
lance said:
Part of a paragraph appearing in the Conclusions section on POC home monitoring reads in part "most patients not good candidates for self testing and self management.
Click to expand...

I can imagine that this opinion/information comes from the large amount of patients on Anti-Coagulation Therapy that are quite elderly, and do NOT want to take charge of their medical care. They have been told all their lives, "Do what the Dr. tells you.", and they do. I'm not bashing them at all...it's just the way it is. If someone wants to let the Dr. do it all, they are not good candidates for home testing. I believe you must want to be in control of your Anti-Coag Therapy for it to be effective.

We cannot fault the researcher for the information he uncovers. As my generation ages (I'm 46), we will be more in charge of our healthcare, mainly because we already ARE!. We have much more access to medical information, and how things affect our lives. I know that when my mom (69 y/o) was on ACT she had absolutely NO interest in self testing/self dosing, and the woman doing her monitoring was HORRIBLE! (Standard uninformed ACT managers stuff like: It's the generic making you unstable, you'll be more stable on "Coumadin", don't eat green vegetables, drastically cutting the dose (by 50%) for an INR of 5.0, then upping it back because her INR was 1.5...I was pulling my hair out! But through it all, my mom listened to her and did what the woman told her, because that's what she'd been taught all her life.

All in all...there's a place for it all in our world. Variety is the spice of life! :D
 
Here is a link to a paper from Europe that comes to similar conclusions as Dr. Wells. The results are positive, however, there is still a segment of the patient population who will never be able or willing to participate in self testing. In neither of the papaers does it discourage any patient nor anyone in the medical profession from evaluating and approving someone who is committed to participating in their own health management.
Cameron

http://www.anticoagulationeurope.org/hcpselftest.html

"Intrinsic limitations to self-monitoring include the
reluctance of individuals to participate and the extensive
training required. An additional problem of this method
in clinical practice is the high cost of the test strips. The
reliability of self-monitoring devices can affect test
results; however available devices give INR results that
are similar to those obtained in laboratory testing.41 Selfmonitoring
is also associated with a rate of testing that is
higher than that of usual care. In effect, self-adjusted
dosing with warfarin is analogous to self-adjusted dosing
with insulin according to a prespecified sliding scale.42
Such self-adjusted treatment has been practised for
years by diabetics.42 Self-monitoring offers independence
and freedom of travel to selected patients.
Self-monitoring can improve the quality of oral
anticoagulation therapy, with patients more frequently
in the therapeutic range, while improving benefits and
decreasing harms. However, self-monitoring is not
feasible for all patients, and requires identification and
education of suitable candidates. Guidelines exist for
institutions considering implementation of selfmonitoring
of anticoagulation."
 
My strips work out to $7.50 each.....it costs me the same or even a bit more in gas and parking if I test at the hospital.
People are funny; they will spend a small fortune on cigarettes or junk food, but don't want to buy test strips.
Just a thought :)
 
Bina,

I don't know that cost is even a factor in these studies. I truly believe that it hinges on patients who wish to be educated about their conditions and want to be a partner in their own healthcare.

For some...that's just too much.
 
You must log in or register to reply here.

Latest posts

Back
Top