D McCahon et al. Does self-management of oral anticoagulation therapy improve quality of life and anxiety? Family Practice, November 10, 2010

Research related to service requirements for anticoagulation management has focused on clinical and health economic outcomes and paid little attention to the impact of treatment and service delivery on patients' quality of life. A study by McCahon and associates was the first large UK study to evaluate the effect of patient self-management (PSM) of oral anticoagulation on treatment-related quality of life (TRQoL) and anxiety in comparison with routine care (RC) and to explore the effect of level of therapeutic control on TRQoL and anxiety across and within each model of care. A quantitative survey, set in primary care in the West Midlands, was conducted. The subjects were 517 randomized controlled trial participants, 242 receiving PSM and 275 RC. Postal questionnaires at baseline and 12 months comprised the State Trait Anxiety Inventory and a treatment-specific measure of positive (satisfaction and self-efficacy) and negative aspects (daily hassles, strained social network and psychological distress) of TRQoL. Change in anxiety and TRQoL scores were compared between PSM and RC. Subgroup analysis was based upon level of therapeutic control (high, medium and low). Overall, 83% (n = 202) PSM and 55% (n = 161) RC patients contributed data. Anxiety scores were similar in both groups. PSM demonstrated greater improvement in self-efficacy than RC across the study period. A statistically significant between-group difference (PSM versus RC) in the self-efficacy also existed in subgroups with medium and high levels of therapeutic control.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: PSM is not associated with increased anxiety and has a positive effect upon some aspects of TRQoL compared to RC.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER: Self-management proved highly effective, both in terms of managing anticoagulation and in developing self-efficacy.