Several studies5 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 NOAC 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 bring6.
Now more than ever we 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.
Self-care, which includes self-monitoring, is a key NHS initiative. It has been identified that there is sub-optimal support for self-care which if addressed may add value improvements.7 For example, self-monitoring could help improve the current under emphasis of a person’s role in managing their illness.
Currently, anticoagulation clinics in NHS hospitals are struggling to cope with the volume of people that attend and they employ staff to take blood samples which are sent off to a laboratory to be tested. Results can take up to four hours to be processed which results in long delays for those attending. Some hospitals have started using portable testing devices to speed up this process to good effect. Nevertheless, self-monitoring is convenient for people and may reduce clinic attendance.
There is also a financial burden placed on the NHS in terms of managing people who are stable on oral anticoagulation therapy. Studies show8 if people were offered a portable INR tester to self-manage, about 25 percent of those stable would readily take up the self-management approach. This could have significant financial benefit even when taking in to account all primary care costs and funding on the prescription of the portable INR tester and test strips.