Effect of a combined education and eHealth programme on the control of oral anticoagulation patients (PORTALS study): a parallel cohort design in Dutch primary care

• Published in: BMJ open 2017-09, Vol.7 (9), p.e017909-e017909
• Main Authors: Talboom-Kamp, Esther P W A, Verdijk, Noortje A, Kasteleyn, Marise J, Harmans, Lara M, Talboom, Irvin J S H, Numans, Mattijs E, Chavannes, Niels H
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Anticoagulants; Anticoagulants - therapeutic use; Chronic illnesses; Clinical outcomes; Cohort Studies; Diabetes; Education; Female; Health Services Research; Humans; International Normalized Ratio; Internet access; Linear Models; Male; Managerial skills; Middle Aged; Mortality; Netherlands; Online instruction; Patients; Primary care; Primary Health Care; Psychotherapy, Group; Quality of life; Self Care - methods; Telemedicine; Thromboembolism; Thrombosis; Thrombosis - drug therapy; Web 2.0; Web portals
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-017909

ObjectivesTo analyse the effect on therapeutic control and self-management skills of the implementation of self-management programmes, including eHealth by e-learning versus group training.SettingPrimary Care Thrombosis Service Center.ParticipantsOf the 247 oral anticoagulation therapy (OAT) patients, 63 started self-management by e-learning, 74 self-management by group training and 110 received usual care.Intervention and methodsParallel cohort design with two randomised self-management groups (e-learning and group training) and a group receiving usual care. The effect of implementation of self-management on time in therapeutic range (TTR) was analysed with multilevel linear regression modelling. Usage of a supporting eHealth platform and the impact on self-efficacy (Generalised Self-Efficacy Scale (GSES)) and education level were analysed with linear regression analysis. After intervention, TTR was measured in three time periods of 6 months.Main outcome measures(1) TTR, severe complications,(2) usage of an eHealth platform,(3) GSES, education level.ResultsAnalysis showed no significant differences in TTR between the three time periods (p=0.520), the three groups (p=0.460) or the groups over time (p=0.263). Comparison of e-learning and group training showed no significant differences in TTR between the time periods (p=0.614), the groups (p=0.460) or the groups over time (p=0.263). No association was found between GSES and TTR (p=0.717) or education level and TTR (p=0.107). No significant difference was found between the self-management groups in usage of the platform (0–6 months p=0.571; 6–12 months p=0.866; 12–18 months p=0.260). The percentage of complications was low in all groups (3.2%; 1.4%; 0%).ConclusionsNo differences were found between OAT patients trained by e-learning or by a group course regarding therapeutic control (TTR) and usage of a supporting eHealth platform. The TTR was similar in self-management and regular care patients. With adequate e-learning or group training, self-management seems safe and reliable for a selected proportion of motivated vitamin K antagonist patients.Trial registration numberNTR3947.