Manage clinic capacity and reduce strokes with self-testing for warfarin patients

Patients can relay readings back to their nurse via a communication method of their choice. If patients choose to use the My Inhealthcare app, the app connects to the Bluetooth Roche CoaguChek INRange, meaning readings populate automatically within the app.

Integration into 4S DAWN

The readings feed into decision support software including 4S DAWN where the next dose is calculated. Patients are then automatically sent their next warfarin dose and date and time of next test via their communication channel of choice. All readings are fed directly into leading GP systems.

GP system integration

If readings fall outside of pre-determined clinical parameters, alerts can be generated to the appropriate NHS team. The GP is able to refer the patient onto the service directly through the patient record, removing the need to log onto multiple systems.

As part of the service, all patients are provided with a self-testing device. Our service also works for patients that already own a self-testing device.

Who uses the service?

Inhealthcare is the UK’s leading provider of self-testing for warfarin patients, with services live at County Durham and Darlington Foundation Trust, Berkshire Community Healthcare, Ilkley Moore Medical Practice, Medway Community Care, Newcastle upon Tyne NHS Foundation Trust, East Lancashire Hospitals NHS Trust and Pennine Care NHS Foundation Trust. 

Inhealthcare’s anticoagulation pathway has been in use at County Durham and Darlington NHS Foundation Trust since April 2014 and currently has 500 self-testing patients. The first 200 patients were evaluated for INR control after 6 months, and again after 24 months.

After 6 months, 70% of the INR self-testing patients saw their time therapeutic range (TTR) improve by 20% compared to 6 months before starting the pathway. The other 30% maintained their TTR. The average TTR across all patients in the group improved by 16%, from 59% to 75%.

After 24 months, the group’s TTR remained high over the 2 year period, and actually increased slightly to 76%.

These findings and the subsequent reduction in adverse events is consistent with INR self-testing patients globally. Patients in standard INR care have an incidence of thromboembolic events of 2.6% per year, whereas for patients that self-test, the incidence of events halved to 1.3%.

The benefits of INR self-testing
Improves clinical outcomes

NICE (DG14) guidance recommends INR self-testing for patients that wish to do so, highlighting our service at County Durham and Darlington NHS Foundation Trust. In a 24 month follow up, 70 per cent of patients improved their time in therapeutic range by 20 per cent compared to in-clinic monitoring, reducing the risk of stroke by a half. This was recently supported in a major Cochrane review of almost 9,000 patients, where INR self-testing halved thromboembolic event incidence.

Reduces appointments

INR self-testing typically reduces appointments from an average of 14 a year to two.

Reduces the time it takes to dose a patient

In Darlington, the time it took to dose a patient reduced from 5 minutes to 30 seconds, giving staff more time to spend with complex patients.

Helps CCGs manage prescribing budgets

INR self-testing is a cost effective alternative to DOACs.

Enables GPs to provide a competitive offering

INR self-testing allows GPs to centralise fragmented anticoagulation services to generate income. Self-testing offers a service delivery model that scales easily, is attractive to patients and can be delivered at low unit cost.

Improves patient satisfaction and meets growing patient demand

Patients do not have to take time out of their day to attend appointments and are not bound to NHS opening hours.

70 per cent of patients improved their time in therapeutic range by 20 per cent compared to in-clinic monitoring.

Ian Dove (Business Development Manager, Country Durham & Darlington NHS)
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