Self-management as the standard of care for vitamin K-antagonist therapy management requires a detailed, point-of-care device-specific training program to ensure quality patient care. In a multi-center trial using the ProTime System (training program plus point of care device), 105 patients were enrolled to evaluate efficacy of training, knowledge retention, patient satisfaction, and quality of life. In the trial described by Voller and coworkers, patients returned to the centers 1, 3, and 6 months after training to complete questionnaires and demonstrate test proficiency. Training assessment employed self-evaluation and comparison of point of care results between self-management and professional operators. Patient satisfaction and quality of life were assessed using a questionnaire and the SF-12 Survey, respectively. Patients demonstrated statistically significant improvements in knowledge after training and retained the acquired information at six months. Trained patients yielded equivalent results to professional operators across all clinic visits. Compliance with weekly testing improved from one to three months, remaining at the required weekly frequency through 6 months. Average patient satisfaction improved significantly during the first month and remained constant thereafter. There was a statistically significant improvement in the Physical Component Summary of SF-12 between baseline and 3/6 month assessments in all centers.

VALUE OF STUDY TO READER. The authors said that self-management requires a comprehensive system including appropriate disease and point-of-care device training. Such a system, they concluded, fostered compliance, improved knowledge, patient satisfaction, and quality of life. The weakness of the study is the usual one found in self-management programs of chronic conditions: the follow-up of 6 months was simply too brief to yield information as to the long-term benefits of the program. This should be determined by conducting additional trials with longer follow-up of the procedure used in the study. It would also be nice if actual patient performance were assessed in addition to knowledge.

H Völler et al. ProTime self-management yielding improvement of fluency and quality of life. Thrombosis & Haemostasis, 2007;98:889-895.