Details of PST or PSM Intervention
The PST or PSM intervention usually included 2 to 4
small group-training sessions of 1 to 3 hours over several
weeks. These were followed by home practice and a test to
ensure competency in all procedures. Training sessions typically
included information on anticoagulant therapy, possible
interactions with foods or medicines, how to use the
INR testing machine, how to dose (usually by algorithm),
how often to check INR, and when to call for help. Patients
often had access to a 24-hour telephone help-line.
Two studies had more intensive training. One study included
one-on-one daily training by a lay educator while
patients were hospitalized, followed by a home visit within
3 days of discharge (23). The second study included a
24-week training program in which responsibility for dosing
was gradually transferred from physician to patient (31,
32). A recent study (34) used an Internet-based direct-topatient
expert system in which patients received dosing
advice from the system after entering their INRs and relerelevant
clinical information.