We are campaigning for greater choice for patients on warfarin about how their condition should be managed. Our goal is to empower patients and we believe where possible they should have the choice about whether to self-test or self-manage their treatment. We believe that this change would enable improved health outcomes and save time and money for both patients and the NHS.
What is self-monitoring?
It is essential for people on long term anticoagulation therapy, such as warfarin, to have their blood tested on a regular basis. People who are measuring their INR themselves, rather than having regular tests at a GP surgery or hospital clinic are said to be self-monitoring. People who self-monitor use a portable INR tester to take a simple blood test. They take a small drop of blood from their finger and report the readings to their health care professional. People can either self-test or self-manage.
Benefits to patients
It has been shown that 77% of people taking warfarin preferred patient self-monitoring to the usual model of care and that fewer consultations and hospital admissions are required when self-monitoring. In short, self-monitoring enables: People taking warfarin to spend greater time in their therapeutic range The ability to test their INR when it is convenient to them Better health outcomes as it reduces the risk of blood clots and bleeding Freedom to travel for business or pleasure People to stay in control of their life
Benefits to NHS
Several studies have shown that patient self-monitoring improves the quality of oral anticoagulant therapy. Those who self manage have fewer thromboembolic events and lower mortality rates. NICE estimate that 46% of patients who are indicated for warfarin or the newer oral anticoagulants (also known as NOACs) not presently anticoagulated. The reasons are multiple; variations in the quality of primary care, reluctance by GPs to recommend warfarin, capacity issues within anticoagulation clinics and the reluctance of patients to take warfarin due to concerns with the drug and the inconvenience it can bring.
The importance of Self-monitoring
The concept of “self-care”, which includes self-monitoring, is well documented as a model to help both clinicians and patients reach a shared approach to managing long-term conditions. The approach brings major benefits to patients including greater symptom management, a feeling of well-being and improved quality of life1. Most recent reviews show there can be considerable cost savings for patients and the NHS through efficiencies achieved in the provision of care. It has been identified that when changes are made to enable patients better to care for themselves by providing information, education, access to experts by telephone or internet and other support that this may then mean a person makes less, or more appropriate, use of services or other resources2.
For those on long term warfarin, a portable INR tester for home use provides the means for many people to manage their warfarin medication from the comfort of their own home and gives them the option to test wherever it may be convenient. People can either self-test or self-manage their INR levels, commonly referred to as self-monitoring. People who are self-testing send their INR reading obtained from their portable tester to their doctor or nurse at an agreed time who will then advise if warfarin dose adjustment is necessary. Those who are self-managing adjust their warfarin dose themselves following training with their doctor or nurse. Read about how self-monitoring has changed the lives of people on long term warfarin
NHS Case Studies
Now more than ever people need to be offered greater choice and control over their care whilst PCTs/CCGs need also identify cost savings and productivity opportunities wherever possible. In view of the clear benefits to patients in terms of greater choice, empowerment, freedom and improved outcomes, combined with the potential to reduce costs through savings from anticoagulation monitoring and potentially reducing the number of patients prescribed more costly new oral anticoagulants (NOACs)1, there are a number of exemplar sites now offering support for self-monitoring. Read more about NHS exemplar sites
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