Abstract 176: Technology Use Among Patients Undergoing Warfarin Therapy: A Report from the Michigan Anticoagulation Quality Improvement Initiative (MAQI2)

Abstract

Background: Anticoagulation therapy with warfarin often requires frequent communication between patients and their anticoagulation providers. Providers communicate the current dose schedule, INR/PT lab results, schedule the next blood draws, and ask for updates in patient status such as new medications, changes in health, diet, or activity. Currently, these interactions take place mostly in the form of phone calls and voicemails from anticoagulation nurses to their patients. With the widespread adoption of new telecommunications technology, there is an opportunity to leverage the capabilities of mobile devices to facilitate communication between patients and their providers in order to enhance patient engagement and support clinical care goals. Methods: To assess the current use of technology among warfarin patients and the potential utilization of mobile devices in anticoagulant therapy, we surveyed 136 patients from two sites of the MAQI2 consortium. Survey questions investigated the use of technology for health information and comfort using mobile devices in this cohort of patients. The survey asked whether patients undergoing warfarin therapy believe a mobile device, a smartphone/tablet, would be useful to support instructions. Responses were linked to each patient’s health record by their MAQI2 ID to characterize them based on demographics and indicators of quality of care such as time in therapeutic range (TTR) and the number of out of range INRs. Results: The survey results show that 84% of patients who responded to the survey have internet connectivity at their home. In addition, 66% reported that they always or sometimes use a computer to find health information compared with 34% who rarely or never go online seeking health information (p<0.01). Patients who are comfortable with mobile devices are on average 14 years younger, 57 vs. 71 years old (p<0.01). About 70% of patients responded that a mobile device would be useful to support warfarin instruction and 44% of these patients responded that they would be capable of using a device to support their warfarin therapy. These patients that responded favorably to mobile devices have a lower TTR 40.6% vs. 64.2% (p<0.01), and almost twice the rate of out of range INRs with known reasons (p>0.05) for example such as a change in medication, diet, or because the patient took more/less warfarin than prescribed. Conclusion: A majority of warfarin patients surveyed have internet connectivity at home, and they currently use a computer for health-related purposes. Patients who are most likely to use a mobile device to support instructions and communicate with their providers are younger and spend less time in therapeutic range. Quality of care may be improved in this population through an online/mobile application as a resource to communicate dose changes, remind patients of scheduled blood draws, and collect changes in patient status.