MC-SAT: A Telemedicine Management System Utilized to Monitor Oral Vitamin K Antagonists Treatment

Abstract 4742

The MC-SAT program is a telemedicine system developed for the management of patients under oral anticoagulant treatment (OAT). The program constitutes the natural evolution of an original research project, which assessed the capability of a telematic system in managing different chronic patients access flow to health care services. In particular, for patients on oral anticoagulation we planned a direct access to a call center server and a pre-process of the INR data obtained through self-testing with portable prothrombin time (PT) monitor. The original project performed the technology assessment of all the devices and procedures able to automatically drive international normalization ratio (INR) data from patients to specialists in a hospital anticoagulation clinic and to get patients able to read the medical answer. The ability of patients and/or general practitioners to self-determine INR without specific training and the integration of a portable PT monitor for home use into routine patient care in anticoagulation clinics was subsequently successfully evaluated. After a pilot phase of the project, during which the feasibility of the MC-SAT telemedicine service was assessed, we started the enrollment of consecutive patients. Controls matched by age (+/− 5 years), sex and therapeutic range with the cases, were selected among those who attended our anticoagulation clinic (whose population reaches 3,557 individuals) and were managed by usual care. At the beginning of the program, which is still ongoing, a portable monitor (Coagucheck®, Roche Diagnostics, Germany) has been given to 40 patients and to 10 general practitioners (GPs) provided with portable monitors and Internet access. Each GP had the task to follow 5 patients on chronic OAT. Subsequently, additional 40 patients joined, referring to the preferred community laboratory to perform the prothrombin time and subsequently send the INR results through MC-SAT. To date, the system works like this: the INR data, obtained through the portable monitor or through a local laboratory, is sent by GPRS cellular phone or by Internet computer. When an alert output is detected, an automatic message is sent to the specialist. GPRS services are implemented in order to connect the specialist to the database containing the clinical history of the patient. The specialist is able to monitor, from any location, by means of smartphone or tablet PC, all INR values recorded by the system, all the previous patient accesses to the hospital and the last weekly OAT dose. On these basis, if necessary, a change of the weekly OAT doses is made and transferred to the GP's or patients' computer. Since the start of this project in its definitive shape in june 2009, we enrolled 130 patients allocated to prolonged oral anticoagulant treatment. Of these, 80 were directly assisted by our clinic. The remaining 50 patients were assigned to the GPs. Of the 130 patients originally enrolled, 39 never provided any data. These 39 patients were among those assigned to the GPs. Even if periodically urged to do so, GPs sent data on 11 patiens only. Of the 80 patients directly assisted by our clinic, who utilized either the given portable monitor or referred to a community laboratory, 69 showed great interest to the program, did send their results and continue to do so, utilizing the system 1104 times during the period july 2010-june 2011, with a mean of 16 prescription/year/patient. No significant differences were recorded in the TTR (time in therapeutic range) between the patients enrolled and the controls. More than 80% of the answers were given before 9 hours from the request. After two years, we confirm that the use of the system represents an improvement in the management of patients under oral anticoagulant treatment, by favouring communications and, potentially, clinical outcomes. The program showed to work better when it involves the individual patient rather than GPs.