The Anonymous Widower

Is There A Need for a National Anticoagulation Service?

Like many people in this country, I’m on Warfarin.  This means that I have a blood test every week or so and answer a few questions about how you are getting on and if you have missed a dose.  The hospital managing your anticoagulation service, then does the analysis for your INR and calculates your daily dose and date of the next test.  If there is a change in the dose, you are told immediately by phone, usually within twelve hours of the blood test.  On the next day, you get a letter from the hospital confirming the dose and giving the date of the next test.

I have found that one of the subsidiary effects of my stroke, is a need to solve problems and design systems that work. So after the problems with the phones last week, where if there had been a dose change, they wouldn’t have been able to phone, I got to thinking about how the service could be improved.

So what problems can I see?

1. For me giving blood for a test is very easy. Although I am right-handed, because of my gammy left arm,  I prefer the test to be taken out of my right arm.  A week ago, they took blood in the hospital on the Friday and then I had another test on the Monday for the Warfarin. It was no problem at all. But my late wife, C, found giving blood for a test almost impossible.  So we’re all different.
2. The letter I get for each dose, is one of those awful NHS letters, that because of my hand, I find very difficult to open. Or I would, if I didn’t have a very good pair of scissors! There must be many on Warfarin, who have much worse hands than me!
3. I live in the countryside and I have the blood test either at the GP surgery or at my local hospital. As I can’t drive, this means I have to make sure on test days, my driver comes in.  It’s not a great expense and I usually do all my food shopping at the same time, but it could difficult for those who have to go to the local hospital, where transport is difficult.
4. Perhaps my biggest problem, is that I travel a lot and might not be in the right place for a test. I can have them a day late, but I like to be precise in getting my dosage right! This travelling might also mean that I don’t get the letter until a few days after the test.  This doesn’t matter as regards the dosage, but knowing the next test date might be important.

So what is available to improve the excellent service, I get from the NHS.  And in these times of austerity, could a service be designed that was not only failsafe but cost less to run?

There are machines now to self-test for your INR, just like diabetics test for the amount of insulin they need. I used to think that this might be the way to go for me, as I’m pretty tech-savvy, but the machines aren’t cheap and it means that when I travelled, I’d need to take it with me.  I’ve tried hard to avoid carrying excess baggage for years and now that I’m not as strong as I was, I don’t want to start adding to it.  And my gammy left hand might drop and break it!

On the other hand, these machines only take a pin-prick of blood.  So would they be much better for people like my late wife?

Technology has also moved on in the fields of communication and I now am reminded of my hospital appointments by SMS message.  So there must be ways that technology can improve the service!

So what could a service look like? 

I have said in the title to this post, that it might be National, but that might bring in other problems, like Data  Protection.  Incidentally, I don’t bother about that for my health records, as anyway most of my problems are already available to everybody in this blog. 

Like now it should be based on a network of testing stations.  There could be two sorts; ones that worked as now and sent the blood samples to the hospital and others that worked using pin-prick style machines, which give a direct INR reading. In the case of the simpler systems, all it would need would then be to enter them into the Service through a web page or even by phone to the hospital. Obviously, various routes could be allowed, so that patients who might be confused, weren’t upset. 

The advantages of multiple testing stations are that you can go to the one that is most convenient.  Suppose too, that pharmacists were licensed to do the test, so that you could do your test when you went to the shops.  It would be much easier for me to go to Boots in Newmarket, than have to go all the way to the West Suffolk Hospital, because the blood nurse at the surgery was too busy or on holiday. 

Multiple testing stations would also mean that, when I was travelling, all I’d need to do was find an accredited testing station.

As the testing stations would get your INR almost instantly, once it was in the Service, the results would be immediately available.

But it is in the distribution of those results that the greatest improvements can be made. We have five basic methods of communication; letter, e-mail, phone, mobile phone and SMS message.  You should be able to choose how you want to be told and all of them can now be done automatically. I would take an SMS message with a letter for backup.

I elieve that properly designed such a system would work very well.  The problem with it would be that some anti-coagulant departments in hospitals would no longer be needed.  So what would the Unions have to say on that one!

September 12, 2010 - Posted by AnonW | Computing, Health | Hospitals, Warfarin