There is significant interest in self-management among Norwegian patients who receive warfarin treatment (INR self-management (self-monitoring and self-dosing)), or INR self-monitoring only.

Over a number of years Noklus has built up its expertise in providing such training in accordance with international guidelines. The training provided is made available in collaboration with local health enterprises.

Many factors affect INR levels and will influence the dosage. Patients respond in different ways to these factors, and scrupulous follow-up of the warfarin treatment is therefore required. The objective is for the patient's INR values to be kept within the therapeutic range in order to reduce the risk of complications such as bleeding, thrombosis and death.

A local study (not published) conducted in the county of Nordland in the period 2008-2012 showed that when self-monitoring was used, rather than conventional treatment, the proportion of INR values within the recommended range increased from 65% to 79%. Six months after the training had been completed this had increased to 82%. Self-management makes patients more knowledgeable, and they enjoy a greater sense of freedom and confidence in respect to their own situation.

If a patient is interested in participating in the training programme, the patient's general practitioners assess whether the patient is a suitable candidate for self-management (or only self-monitoring). It is also essential for the training that patients have a good grasp of the Norwegian language, since Noklus only offers this training in Norwegian.

The training programme runs over a 21-week period and involves three interactive sessions. To ensure that patients have the right blood sampling technique, that they manage to operate the instrument ant that their devices give correct readings, blood tests are taken regularly to compare the INR readings of these devices to hospital instrument readings. On completion of the training, a compulsory theory test has to be passed to be approved for continued self-management of their warfarin treatment.

It is important to emphasise that the training and the final test are essential to ensure the self-management regime is safely implemented. Even if the local health enterprises buy the test meters and the test strips, their use should always be linked to a training programme. Noklus has the necessary self-management experience and expertise and offers standardised and quality assured training programmes throughout Norway.



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