INR self-testing: Scotland reignites the independence debate
Over 13 000 people in and around Glasgow rely on warfarin to help minimise their chances of having a stroke. Warfarin therapy, whilst being highly effective as the treatment of choice for conditions such as Atrial Fibrillation presents lifestyle challenges for its recipients.
Warfarin patients become very dependent on face to face consultations often have to undertake regular routine visits to the clinic in order to test their blood coagulation, and determine their warfarin dose. These clinics tend to be delivered during the usual 9 – 5, Monday to Friday and often involve the patient having to navigate public transport, find a space in a busy waiting room or stump up cash to park the car. For the working patient it may mean taking time off work, losing pay or interrupting holidays or other commitments.
Across the UK, a small number of patients have been INR self-testing (the measure of the rate at which the blood clots)– the idea that a patient can be given a small hand held device, shown how to use it to take a small blood sample and measure their own INR all without going near a clinic may sound sensible – and attractive to those patients seeking independence.
The challenges in the past have been how clinicians can then check and alter the dose and ensure there aren’t any other changes with the patient’s presentation that might compromise the therapy. Roche, in conjunction with Inhealthcare have developed a fully managed INR self-testing service that now allows patients to measure their own INR, answer some simple questions about their general health, send the readings into the dosing software and get the new dose and next test date back to the patient – quickly, securely and all without the patient having to interrupt their daily lives. This data can be integrated into clinical systems. This means that patients are provided with a CoaguChek device to self-test, but are also monitored by their care team. Patient data can integrate into clinical systems meaning that their health is closely monitored, without the associated costs and hassles or clinic visits
Evaluations of this service are excellent – it improves the efficacy of the warfarin therapy – improved and increased TTR (from 59-75%), supports efficiency drives through reducing the reliance on clinics and patients universally love it.
So in Glasgow, Roche have launched a campaign to promote independence through the use of this service. Throughout the Autumn a TV ad is being broadcast across the region. It shows the warfarin patient Alec, who now has the freedom to spend his time in the garden rather than making inconvenient trips to the clinic. The supporting leaflet also explains how easy self-testing can be, and how it’s suitable for long-term warfarin patients of any age. This initiative is aiming to work alongside clinics in the region to promote and raise awareness of self-testing
Digital health should be all about increased efficacy and improved efficiency – primarily it should be used to promote independence, to allow patients who need to regular monitoring to maintain their ability to lead uninterrupted lives.
Here is a great example of a service that ticks all the boxes – and should be successful in enabling Scotland to say YES to this particular independence debate.