ANTICOAGULATION IN PRIMARY CARE

The Sea-Urchin Model !

Who am I ?

Dave Bottoms, Pathology Services Manager

South Durham Health Care

Teespath IT Project Manager

THE HUMBLE SEA-URCHIN

Pressures on Anticoagulation Control Services

• Too Many Patients• Overcrowding• Delays• Angry Patients• Stressed Staff• H&S Issues• Complaints• Mistakes• Litigation

ALTERNATIVE SOLUTIONS

• Improve Secondary Care– More clinics– Faster clinics

• Use of NPT• More staff (phlebotomists, practitioners)

• Take the patients out of the Secondary Care– Dosage at Home

• by healthcare workers• Self-control

– Dosage in Primary Care• In the GP Practices• ? Other locations

• Change the anticoagulant drug to one that does not need blood test monitoring

BENEFITS OF DOSING IN A PRIMARY CARE SETTING

1. Patient Access – closer to home

2. Less delay

3. Less hurried appointments

4. ? More flexibility on dates

5. ? Clinician better briefed on holistic care

6. ? One-stop visit

DISADVANTAGES IN TRANSFER TO PRIMARY CARE

1. ? Less control/ standardisation of treatment

2. Fragmentation of DAWN Database

3. ? Results do not get into Pathology Database

4. ? Need to move to NPT

5. ? INR results less accurate

6. Training Demands

7. Cost

8. Manpower Resource

PRIMARY CARE OPTIONS

Option 1. DAWN AS STAND-ALONE IN EACH LOCATION

Benefits

• Comprehensive In-house Control

Drawbacks

• Very expensive

• Fragmentation of Database

PRIMARY CARE OPTIONS

Option 2. DAWN PROVIDED AS SECONDARY CARE LAP-TOP

Benefits

• Retention of centralised database

• Affordable

Drawbacks

• Involves travel time for key staff

• Exposes data to risk (while in transit)

PRIMARY CARE OPTIONS

Option 3. TRANSFER OF INFORMATION VIA DISC/ CD

Benefits

• Retention of centralised database

• Affordable

Drawbacks

• Involves travel time for key staff

• Exposes data to risk (while in transit)

OPTION URCHIN

• Electronic upload of data from central database through Dial-up link (NHS Net)

• Manipulation/ update in primary care• Electronic download back to central database

through Dial-up link (NHS Net)

Option : Urchin

BenefitsRetention of centralised databaseAffordableNo staff travel requiredFar less risk with no-risk potential

Drawbacks?

PRIMARY CARE OPTIONS

Set up across Co Durham and the Tees Valley in 2001/2002 includes :

• South Tees Acute Hospitals NHS Trust– James Cook University Hospital– Middlesbrough General Hospital– Friarage Hospital, Northallerton

• North Tees and Hartlepool NHS Trust– University Hospital of North Tees, Stockton– Hartlepool General Hospital

• Durham and Darlington Acute Hospitals NHS Trust– Darlington Memorial Hospital– Bishop Auckland General Hospital– University of Durham Hospital

A PATHOLOGY CLINICAL NETWORK

Teespath Projects

• Anticoagulant Dosing in Primary Care

• Lab to Lab Links

• Anglia ICE Requesting

• Better Blood Transfusion

• Telepathology

• Document Management

North Yorks Moors

S Tees

Northallerton

N Tees

Darlington

Bishop Auckland

Durham

Hartlepool

THE HOSPITALS

North Yorks Moors

S Tees

Northallerton

N Tees

Darlington

Bishop Auckland

Durham Hartlepool

HOSPITAL CATCHMENTS

AN IDEALISTS VIEW

North Yorks Moors

S Tees

Northallerton

N Tees

Darlington

Bishop Auckland

DurhamHartlepool

FUTURE SAMPLE TRANSFER

The North

The South

HOSPITAL CATCHMENTS

THE TRUE PICTURE

NursingHomes

RESULT AVAILABILITY

Mental Health

Cancer Centre(s)

Primary Care

Tertiary Care / Referral LabsDMH

HA

Darlington Memorial Hospital

OUR PRIMARY CARE SECTORS

Darlington PCT

The Dales PCT Sedgefield PCT

ANTICOAGULANT DOSAGE IN PRIMARY CARE

• Reduce Clinic Overload

• Improved patient access

• Sustain single database

• Standardise dosing procedures

DMH

BAGH

Shildon

S Tees

N Tees

Hartlepool

Friarage

• Reduce Clinic Overload

• Improved patient access

• Standardise dosing procedures

DMH

BAGH

Shildon

S Tees

N Tees

Hartlepool

Friarage