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Abstract
Objectives To 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.
Setting Primary Care Thrombosis Service Center.
Participants Of 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 methods Parallel 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.
Results Analysis 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%).
Conclusions No 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 number NTR3947.
- –oral anticoagulation
- TTR
- eHealth
- self-management
- self-efficacy
- e-learning
- thrombosis
- self-monitoring.
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Footnotes
Contributors ET is the principle investigator and contributed to all aspects of the research. NV assisted on all aspects. MK assisted on the statistical analysis. NV, MK, LH, IT, MN and NC are responsible for revising the manuscript several times. IT is responsible for the acquisition of data. NC is responsible for the concept and design. All authors read and approved the final manuscript.
Funding This work did not receive any funding.
Competing interests None declared.
Ethics approval The Medical Ethics Committee of the LUMC approved this study (Reference No. P12.278).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data will be made available for sharing where available and appropriate.