TORONTO - An automated system that provides information to thrombosis patients who take the blood-thinning medication warfarin to prevent blood clots was just as effective as telephone calls from a human, a new study suggests.
The system reduced workload for health workers by one-third, according to results of the study, published Monday in the Canadian Medical Association Journal.
And the patients didn't seem to mind getting calls from the automated system, with more than three-quarters of them agreeing to stay on the system after the study had ended, said Dr. Alan Forster, a patient safety expert with the Ottawa Hospital Research Institute and the University of Ottawa.
Dianna Siteman, 65, of Navan, Ont., near Ottawa, was one of the patients who participated and she described the automated system as "the greatest thing in the world."
Siteman developed phlebitis in 1966 after her first child was born and has been taking blood-thinners ever since, except for one ill-advised period of time many years ago when she quit taking the medication and ended up having a heart attack.
Being on the automated system "gives you a lot of confidence," she said.
"I get a phone call one or two days before to remind me of my appointment," she said. "Then I go down and get my blood test and I get my results usually in 24 hours ... they will tell me my results and then they will tell me my dosage until the next time."
Forster said a lot of people take warfarin for blood-clotting disorders, but the dose has to be individualized. Even within individuals, it has to be monitored quite closely, he said.
"If the dose exceeds a safe range, people are at quite a high risk of bleeding, and if it drops below the effective range, then you can be predisposed to the clots."
Patients have to go for blood tests anywhere from several times per week to monthly to see if they're in the correct range. Then the clinics have to make decisions based on the results, and communicate them to patients, along with instructions for any changes in dosage.
"That process of calling people, and also the interpretation of the results - there is some intelligence required for that, but it's an intelligence that can be automated," Forster explained.
Computer algorithms can predict the right dose, he said, in a way that's better than a person predicting the dose.
"The results from the lab gets entered into the computer system, the computer system has the previous result, and can actually from those predict what the next dose should be," he said. "So the computer predicts the dose."
A pharmacist double-checks to ensure everything is fine, Forster said, and then an automatic call is made to the patient.
A total of 226 patients took part in the study, and received their dosing information in this manner for about four months.
"It works well in these patients who are well controlled," Forster said. "It frees up time to look after the patients who are not in good control. The people who are not in good control are the people that the computer is not going to be good at looking after anyway."
Siteman said she doesn't mind the fact that it's not a human providing her with information. The automated system asks her if she understands everything, queries her about whether she wants the information repeated, and also asks if she wants to speak with a person.
"You feel good because you know they care," she said. "Even if you're talking to 'not a human."'
