Self testing for those on anticoagulant treatment
At the end of a working week where self-management of those on anti-coagulant treatment has been a major focus, it has highlighted some key areas:
- We have a significant number of people (approximately 1,000,000) on anti-coagulation treatment in the UK.
- We can make a significant impact on the management of Atrial Fibrillation and stroke prevention, whilst reducing NHS costs if we truly pushed the NICE guidance on self-management.
- A large percentage of those on anti-coagulant treatment have severe restrictions on their lifestyle because they’re tied down to pathways, clinics and outpatient departments.
- A lot of hard working clinical and service management staff are hamstrung by barriers to change resulting from short term financial focus.
Last week, I caught up with the charity Anti Coagulation Europe (ACE) who are a strong voice for those on anticoagulant treatment. Our discussion identified real disadvantages our patients are facing as a result of our somewhat ‘disempowering’ traditional approaches to care delivery. These included:
- Many patients feel disadvantaged at job interviews because they needed to ask for regular time off to attend clinics.
- People taking unpaid leave to find out they are still inside the therapeutic range for their dosing of warfarin.
- People moving to more expensive drugs because the self-management options on cheaper anti-coagulant drugs are simply not publicized.
- Restricted lifestyles of those who can’t go on holiday abroad as they can’t be certain of any support whilst away.
Self-testing brings real benefits to patients. Here are some examples of how self-testing has impacted patient lives for the better:
- Mr A works on an oil rig in the North Sea and no longer has to fly back to Durham for his new warfarin dose.
- Mrs B is a Director in a large international company and no longer has to keep cancelling appointments due to work commitments.
- Mr C no longer has to risk his life during the winter to travel a 40 mile round trip to the Durham Dales to outpatients
- Mrs D was able to spend the last months with her mother and sister before they died in Manchester without worrying about having to travel home to the clinic for INR testing.
So what are the perceived barriers to self-testing that are getting in our way?
- The short term commissioning and benefits approach. But as well as quality and outcome improvements, the costs of offering effective self-management will be outweighed by savings on reduced stroke and unnecessary movement to more expensive drug therapies.
- Concerns over quality and consistency of readings by patients. Evidence demonstrates well trained service users show definite improvements in time in therapeutic range.
- High costs. Costs and leasing deals to make the service free at the point of delivery. Through leasing deals the service is made affordable.
How do we enable service users and staff to get on board with self-testing?
- The Government is pushing for patients to take authority. NICE has provided the guidance for people and commissioners to have self-testing as an option.
- Enable staff access to the right resources. Self-testing will also in time free up clinic resources.
- Enable access to patient information. Patient readings need to be able to flow into patient records.
- Accountability for care commissioners and care providers to both provide and support the roll out. Patients are encouraged to take personal accountability for their own care.
- Skills for service users are the key enabling piece and approaches to help them become self-managing expert patients.
INR self-management is here and it works. So what are we waiting for? Self-management of anti-coagulation is working and it is affordable. We just need to empower both patients and staff to do it.