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

[Karlynn]

I'm wondering how many of the people in the study who turn down the offer of home testing, or fail to do it adequately are initially psyched out by those "helping" them home test. I guess I'm wondering how much Self-Fulfilling Prophecy plays a part. (This will be much too hard for you to learn and do yourself, but we'll try.)

I still say people need to get a grip and take a look at the millions of diabetics that test themselves several times a day, decide their own insulin dose and give themselves a shot. Can you imagine the statistics of traumatic incidence if all diabetics were expected to go to a lab daily and speak with a medical professional each day to decide dose. There would be a huge amount of non-compliance.

As far as the elderly go. My Dad was diagnosed with Type 2 diabetes at 78 and no one ever even considered making him go to someone for his tests and shots.

 

[lance]

Mostly supportive pf POCD's except ................

Mostly supportive pf POCD's except ................

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.

Hello Cameron,

Isn't it too bad than an otherwise supportive use of POC devices is somewhat negated by two sentences.

The first on the Abstract, Conclusions, 1st sentence: Use of POCDs is safe and may be more effective. However most patients are not appropriate for self-testing/management.

The second at the end of the paper before the reference section:

"Widespread adoption of POC monitoring at this time would be premature."

That would colour any PCP's attitude towards a new device. Also maybe Wells favours their use at medical facilities rather than patients at home.

My husband attends a cardiac Rehab Clinic attached to a hospital performing open heart surgery and was told that home monitoring devices are dangerously inaccurate. I wish I had been there. Also when my husband was discharged from the cardiac ward he was advised to take 2 mg of warfarin daily for a range of 2-3. Totally inadequate.

Now I ask who/what is dangerously inaccurate in the anticoagulation field.

And yes, I did via e-mail offer to put him in touch with about 200 successful users of home monitors. I'm still waiting for a response. Ho hum

 

[ALCapshaw2]

Home Testing is Very Common in Europe, especially Germany.
Maybe you can find something from there to support your case.

Also, Medicare in the USA approves of Home Testing and has a long statement outlining their decision. I believe it has been posted on VR.com somewhere.

'AL Capshaw'

 

[Blanche]

Medicare and Point-of-Care-Testing

Medicare and Point-of-Care-Testing

I believe this is the document that Al Capshaw mentioned.

https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=72&

Blanche

 

[ClickerTicker]

Home testing in the UK has a sort of "government blessing" as the testing strips and lancets (at least for CoaguChek) are available at vastly reduced price via our National Health Service prescriptions. If you are over 60 all prescriptions including these are free.
The Coag labs don't seem really comfortable with self-testing however. In our area there's no dosing service for people self testing. It's do it all yourself or nothing - obviously experienced self-testers don't have an issue with this, but it is somewhat daunting for people just starting out.

 

[lance]

Kudos to Dr. Wells

Kudos to Dr. Wells

for responding to my e-mail saying in part:

Sometimes things work better in real life especially after all involved parties get comfortable with the idea.

and

he certainly agrees more patients deserve point of care monitors. Hopefully patients on ACT/OAT will be exposed to the benefits derived from home monitors.

 

[Cameron]

Glad to hear that you got a response. Thanks for sharing some of what he had to say. Is he doing any further studies that we all could participate in?
Cameron