ANTICOAGULATION IN PRIMARY CARE

1. ANTICOAGULATION IN PRIMARY CARE The Sea-Urchin Model !

2. Who am I ? Dave Bottoms, Pathology Services Manager South Durham Health Care Teespath IT Project Manager

3. THEHUMBLE SEA-URCHIN

5. Pressures on Anticoagulation Control Services • Too Many Patients • Overcrowding • Delays • Angry Patients • Stressed Staff • H&S Issues • Complaints • Mistakes • Litigation

6. 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

7. 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

8. 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

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

10. 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)

11. 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)

12. 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)

13. PRIMARY CARE OPTIONS Option : Urchin Benefits Retention of centralised database Affordable No staff travel required Far less risk with no-risk potential Drawbacks ?

14. 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

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

16. THE HOSPITALS Durham Hartlepool Bishop Auckland N Tees S Tees Darlington North Yorks Moors Northallerton

17. HOSPITAL CATCHMENTS AN IDEALISTS VIEW Durham Hartlepool Bishop Auckland N Tees S Tees Darlington North Yorks Moors Northallerton

18. 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

19. RESULT AVAILABILITY Mental Health Cancer Centre(s) Primary Care Tertiary Care / Referral Labs DMH NursingHomes HA

20. OUR PRIMARY CARE SECTORS The Dales PCT Sedgefield PCT Darlington Memorial Hospital Darlington PCT

21. ANTICOAGULANT DOSAGE IN PRIMARY CARE Hartlepool BAGH • Reduce Clinic Overload • Improved patient access • Sustain single database • Standardise dosing procedures Shildon N Tees DMH S Tees Friarage

27. Hartlepool BAGH • Reduce Clinic Overload • Improved patient access • Standardise dosing procedures Shildon N Tees DMH S Tees Friarage