- ICH GCP
- 미국 임상 시험 레지스트리
- 임상시험 NCT03295799
Patient-Centred Care for Warfarin Management: A Pilot Study to Transition Care to High Risk Patients
연구 개요
상세 설명
50 patients will receive a cover letter outlining their random selection for this study, along with the patient information sheet and consent form (with a return addressed, postage paid envelope). Patients will be encouraged to contact the AC and speak with the Principal Investigator (TB) regarding the research study, and all questions will be addressed. We will continue this mailing process until a total of 50 patients have consented to study. PSM within the context of this study may use either POC technology or standard venipuncture with the patient accessing the laboratory for results. After receipt of consent, patients will be required to pass a foundational exam (outlining the basics of anticoagulation therapy, most of which should be simple review for the patients managed within our AC).4,10 Upon successfully passing this multiple choice exam, patients will be randomized to AC care (with no changes implemented) or to PSM.
PSM Phase I: Preparatory Phase of Patient Training (~6weeks) During the initial preparatory phase lasting 6 weeks + 2 weeks, the AC will create a patient specific warfarin dosing nomogram, discuss the same with the patient and ensure clear understanding, while working through various scenarios with the patient (Appendix 1). The AC will ensure the patient has an established system to both retrieve INR results (via POC technology or standard venipuncture) as well as to document the INR results, warfarin dosing, any pertinent assessment factors, and next date to test the INR. The AC will empower the patient to be proactive with coming up with warfarin dose changes during this preparatory phase.
PSM Phase II: Patient Practical Training:
The AC will enrol the patient into the PSM practical training phase (lasting 3 months + 1 month). At this time, the patient will retrieve their result and establish a future warfarin dose and follow-up plan. This information will be transmitted to a single AC team member. Contact with anotherdiscussed with an AC team member and the ultimate dosing decision will be tracked to ascertain concordance of the patient's original plan to what was implemented during the follow-up visit with the to perform standard AC teamcare and management will occur, thereby enabling comparison of the patient's plan and the AC plan. During this phase, the AC plan will be implemented. At the end of this phase, patients must pass a multiple choice exam that provides practical cases targeting warfarin dose adjustment with next scheduled follow-up visit, and will then be positioned into the PSM arm of the study.
Patient Self-Management During the PSM phase (6 months +/- 1 month), contact will occur with the AC monthly to retrieve INR results and warfarin dose adjustments (information from the patient-based charting system). Key points of contact between the patient and the AC will be required, such as: INR results either > 5.0 or 0.5 INR units below the lower limit of their desired target INR range, initiation of interacting medications, illness, etc. Patients not demonstrating the ability to self-manage their own warfarin therapy will be encouraged to cross-over to AC care. At the end of 6 months, patient choice of AC care or PSM will be identified.
연구 유형
등록 (실제)
단계
- 해당 없음
연락처 및 위치
연구 장소
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Alberta
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Edmonton, Alberta, 캐나다, T6G 2J3
- University of Alberta
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참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion Criteria:
- mechanical heart valve as the indication for warfarin
- > 16 years of age
- Warfarin therapy managed by the AC for at least the preceding 6 months
- Anticipated duration of warfarin therapy to be lifelong
- Previously adherent with medication
- Competence judged by demonstrated ability to use drug-adjustment nomograms
Exclusion Criteria:
• Severe psychiatric disease
- Significant language barrier
- Clinician's judgment that the patient would be a poor candidate for study (with reason specified)
- Known or anticipated procedure/surgery/intervention in the next year
- Active participation in another study
- Lack of access to the internet / email
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 건강 서비스 연구
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
---|---|
실험적: Patient Self-Management
Patients will go through a preparatory phase (creation of warfarin dosing chart, process for documentation and retrieval of labs), a practical training phase (formulate warfarin management plan with support) and then perform patient-self management of their own warfarin.
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Patient will manage their own warfarin therapy.
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간섭 없음: Anticoagulation Clinic Care
Patients will not have their care altered, and will continue to be managed by our Anticoagulation Clinic.
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
---|---|---|
The change in quality of life score (using the validated instruments DASS and Sawicki scale) between PSM and AC care.
기간: 6 months
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Duke Anticoagulation Satisfaction Scale (DASS) and Sawicki Scale
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6 months
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
---|---|---|
The proportion of patients completing PSM
기간: 9 months
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Beginning from consent and capturing stage at which patients withdrew (if applicable) namely the preparatory and practical training phases or PSM as well as those electing to continue PSM after study
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9 months
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Difference in the time in therapeutic INR range between those randomized to AC care versus PSM.
기간: 6 months
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Time in range will be calculated using the Rosendaal method.
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6 months
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The rate of ER and hospitalization for anticoagulant and non-anticoagulant reasons between AC care and PSM.
기간: 6 months
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presentations to hospital
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6 months
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The amount of time spent by the AC team for the AC group relative to the PSM group.
기간: 9 months
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the number of minutes taken for each arm, as a measure of resource use within the AC team.
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9 months
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Amongst the PSM group, to determine if strategies for self-managing warfarin therapy have made patients do so for other chronic diseases.
기간: 6 months
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a descriptive measure of translation of proactive management
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6 months
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Number of participants in AC care vs PSM that are dead at 5 years.
기간: 5 years following study completion
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mortality measure
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5 years following study completion
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Number of encounters in the PSM group that put forward warfarin dosing that is concordant with that of the AC and to provide descriptions of warfarin dose changes.
기간: 3 months
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assessed prior to entering the PSM phase
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3 months
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공동 작업자 및 조사자
수사관
- 수석 연구원: Tammy Bungard, BSP, PharmD, University of Alberta
연구 기록 날짜
연구 주요 날짜
연구 시작 (실제)
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
기타 연구 ID 번호
- Pro00052090
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
미국 FDA 규제 기기 제품 연구
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .
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