Patient-Centered Anticoagulation Self-Monitoring in Minority Patients

Despite favorable results and enhanced patient convenience, the adoption of patient self-monitoring for anticoagulation therapy has been limited primarily to non-minority and higher socioeconomic status individuals. While effectiveness has been studied, the factors influencing the adoption of self-monitoring of anticoagulation in minorities with the most barriers to accessing quality care in specialized clinics, are not known.

Hypothesis: Patient centered education and training intervention for minority patients will result in effective adoption of self-monitoring of anticoagulation therapy, resulting in anticoagulation control of comparable quality to that seen in specialized anticoagulation clinic-based monitoring.

The research objective of this proposal will be accomplished through 3 specific aims:

• Identify patient and provider factors that influence adoption of anticoagulation self-monitoring in a minority population.
• Adapt and refine an education intervention that both addresses identified barriers and emphasizes identified positive influences to anticoagulation self-monitoring.
• Demonstrate the feasibility and effectiveness of anticoagulation self-monitoring coupled with an educational intervention in a minority population.

Inclusion criteria

• > 21 years of age
• African American or Hispanic
• English speaking
• Has been on warfarin therapy > 3 months
• Plan to be on warfarin therapy > 12 months
• Willing ( or caregiver be willing) to do self-monitoring
• Willing to be randomized

Exclusion criteria

• Lack of access to a telephone
• Moderate to severe dementia (if lacks caregiver)
• Severe hearing impairment ( if lacks caregiver)
• Blindness ( if lacks caregiver)
• Life expectancy < 6 months
• Antiphospholipid antibody syndrome