Anticoagulation therapy at point of care

There are currently an estimated 750,000 people in the UK receiving oral anticoagulant warfarin therapy and this number is forecast to rise even further over the next decade. The requirement for anticoagulation monitoring has been steadily climbing ever since clinical trials demonstrated that treatment using warfarin significantly reduces the risk of strokes in patients suffering from atrial fibrillation. For anticoagulation prophylaxis programmes to be successful, however, the regular monitoring of the patient’s international normalised ratio (INR) is necessary to ensure that it remains within a specified therapeutic range.

 Out-patient pressures

With growing numbers of new patients now being prescribed life-long warfarin treatment to combat this risk, many haematology departments are finding it increasingly difficult to manage their traditional hospital out-patient clinics. A recent survey by Anti- Coagulation Europe, for example, has revealed that one in five hospitalbased anticoagulation clinics may have to limit the numbers of new patients they accept due to increasing logistical demands being placed on their services. These pressures are resulting in lengthier patient waiting times, overcrowding and increased levels of stress to both patients and staff alike. The move towards reducing patient travel to and from hospitals and basing their treatment nearer to their homes and communities is also in line with the strategy recently announced to cut overall NHS carbon emissions by 80% by 2050. NHS patient, staff and visitor travel are responsible for approximately 10.5 billion passenger kilometres per year. The NHS Carbon Reduction Strategy for England states that every NHS organisation should routinely and systematically review the need for staff, patients and visitors to travel; consistently monitor business mileage; provide incentives for low carbon transport; and promote care closer to home. Any scheme, therefore, that can reduce the NHS carbon footprint by using more localised, central services will undoubtedly assist in the drive towards a “greener” NHS. Consequently, “one-stop” primary care-based outreach anticoagulant clinics, incorporating near patient testing (NPT) regimes and computerised decision support software (CDSS); located in community-based environments such as GP surgeries, polyclinics and health centres, are now being regarded as the ideal solution to ease the burden on the traditional hospital-based clinics. This has been supported by growing evidence that other healthcare professionals (such as GPs, pharmacists and practice nurses using CDSS) are able to achieve high standards of anticoagulation care. Furthermore, this development is in line with the drive to provide better patient choice over where care is received – as originally outlined in The NHS plan of 2000. This stated that changes were necessary in the delivery of patient treatment and facilities, to provide an integrated service to remove the pressure from hospitals and enable them to concentrate on providing more specialist care.