ANTICOAGULATION IN PRIMARY CARE

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ANTICOAGULATION IN PRIMARY CARE

• The Sea-Urchin Model !

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Who am I ?
Dave Bottoms, Pathology Services Manager South
Durham Health Care
Teespath IT Project Manager
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THE HUMBLE SEA-URCHIN
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Pressures on Anticoagulation Control Services

• Too Many Patients
• Overcrowding
• Delays
• Angry Patients
• Stressed Staff
• HS Issues
• Complaints
• Mistakes
• Litigation

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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

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BENEFITS OF DOSING IN A PRIMARY CARE SETTING

• Patient Access closer to home
• Less delay
• Less hurried appointments
• ? More flexibility on dates
• ? Clinician better briefed on holistic care
• ? One-stop visit

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DISADVANTAGES IN TRANSFER TO PRIMARY CARE

• ? Less control/ standardisation of treatment
• Fragmentation of DAWN Database
• ? Results do not get into Pathology Database
• ? Need to move to NPT
• ? INR results less accurate
• Training Demands
• Cost
• Manpower Resource

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PRIMARY CARE OPTIONS

• Option 1. DAWN AS STAND-ALONE IN EACH LOCATION
• Benefits
• Comprehensive In-house Control
• Drawbacks
• Very expensive
• Fragmentation of Database

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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)

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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)

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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)

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PRIMARY CARE OPTIONS
Option Urchin Benefits Retention of
centralised database Affordable No staff travel
required Far less risk with no-risk
potential Drawbacks ?
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A PATHOLOGY CLINICAL NETWORK

• 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

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Teespath Projects

• Anticoagulant Dosing in Primary Care
• Lab to Lab Links
• Anglia ICE Requesting
• Better Blood Transfusion
• Telepathology
• Document Management

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THE HOSPITALS
Durham
Hartlepool
N Tees
Bishop Auckland
S Tees
Darlington
North Yorks Moors
Northallerton
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HOSPITAL CATCHMENTS AN IDEALISTS VIEW
Durham
Hartlepool
N Tees
Bishop Auckland
S Tees
Darlington
North Yorks Moors
Northallerton
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The North
HOSPITAL CATCHMENTS THE TRUE PICTURE
FUTURE SAMPLE TRANSFER

Hartlepool
Durham
N Tees
Bishop Auckland
S Tees
Darlington
North Yorks Moors
Northallerton
The South
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RESULT AVAILABILITY
Mental Health
Cancer Centre(s)
Primary Care
Tertiary Care / Referral Labs
DMH
NursingHomes
HA
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OUR PRIMARY CARE SECTORS
The Dales PCT
Sedgefield PCT
Darlington Memorial Hospital
Darlington PCT
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ANTICOAGULANT DOSAGE IN PRIMARY CARE
Hartlepool
BAGH
Shildon
N Tees
DMH
S Tees

• Reduce Clinic Overload
• Improved patient access
• Sustain single database
• Standardise dosing procedures

Friarage
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Hartlepool
BAGH
Shildon
N Tees
DMH
S Tees

• Reduce Clinic Overload
• Improved patient access
• Standardise dosing procedures

Friarage
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