As a Healthcare Professional, you are aware of the basic mechanics of anti-coagulation therapy and its treatment. The Coagulation Monitoring section of this website compares the three main models of anticoagulation monitoring. As part of the exploration in this and subsequent pages, the topics below will get special focus.
- Increasing TTR and quality of life
- New oral anticoagulants
- Anticoagulation Clinic model
- Patient Self-Monitoring
Please see the links to the right of this page for further information on this subject.
- Usual care
Most patients taking warfarin are monitored by a hospital doctor or general practitioner (GP) in a traditional model referred to as usual care (UC). Typically patients attend appointments at their GP’s surgery or local hospital. At each appointment a venous blood sample is drawn and sent to a centralised laboratory for INR testing. Once the result is available, the patient is contacted and advised of any change in dose.
Woods, K., Douketis, J.D., Schnurr, T., Kinnon, K., Powers, P. et al. (2004). Patient preferences for capillary vs. venous INR determination in an anticoagulation clinic: a randomized controlled trial. Thromb Res 114(3), 161-165.
- Anticoagulation Clinics vs: Usual Care
Anticoagulation patients are managed in a clinic focused on them; helping personalise warfarin therapy by focusing on:
- Direct, active patient management
- Patient scheduling and tracking
- Accessible, accurate and frequent patient testing
- Individualised patient care
- Patient Self-Monitoring
In many countries Patient-Self-Monitoring is being used to increase time in therapeutic range (TTR) and improve patient outcomes. Studies have shown that Patient Self-Monitoring may increase a patient's TTR and reduce adverse events while improving their quality of life.
CoaguChek® INR testing enables:
- Better patient care
- Improved patient comfort
- Optimised healthcare delivery
- Peace of mind
NICE supports the use of self-monitoring with CoaguChek
- Digital INR
The digital INR model, provided by Inhealthcare and Lumira Dx allows patients to be fully supported by their anticoagulation clinics whilst removing the need to attend the clinic for every appointment. An automated system collects patients' INR levels, which are instantly sent to the HCP, and the apporpriate warfarin dosing is looped back to the patient.
Example of Digital INR Service
On the day of the INR test, the patient receives an automated phone call which asks the patient questions about their INR result and current warfarin dose. It also asks safety questions about bleeding, medication changes and missed doses. Once the patient has completed their call the INR and warfarin data is sent directly to the clinic. The clinician assesses the patient and calculates the patient's new warfarin dose using their existing Clinical Decision Support System. The patient then receives a second automated phone call at a pre-agreed time with their new warfarin dose and date of next INR test. The service fits around the lifestyle needs of the patient.
Health Service Journal, Quality Care Begins at Home. 26th September 2014.