anticoagulation in primary care the sea-urchin model !
TRANSCRIPT
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