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Advise warfarin patients on self-monitoring, says clinical expert

Pharmacists should understand which patient groups are suitable for self-monitoring coagulometers, says Imperial College consultant pharmacist Frances Akor

Pharmacists should make patients on anticoagulation therap aware that they may be able to self-monitor their risk of developing blood clots, a clinical expert has said.

Pharmacists should make patients on warfarin aware that they may be able to self-monitor their risk of developing blood clots, a clinical expert has said.


Nice recommended two self-monitoring coagulometers yesterday (September 24) and community pharmacists should familiarise themselves with the products in case they were asked about alternative treatments by patients on warfarin, said Frances Akor, consultant pharmacist for anticoagulation at Imperial College London.


Pharmacists needed to be aware that the meters were only recommended to adults on long-term anticoagulation therapy – such as warfarin – who suffered from atrial fibrillation or heart valve disease, Ms Akor told C+D.


Some clinical commissioning groups (CCGs) were willing to purchase the devices on behalf of patients and pharmacists should find out whether this was the case in their area, she said.


"Patients might have questions about the cost. It would be useful for community pharmacists to know what's happening in their locality: are patients in charge of doing it for themselves or are CCGs willing to fund the monitor?" she added.  


In its guidance, Nice recommended both the CoaguChek XS system and the INRatio2 PT/INR device as ways to monitor the risk of clotting. Both monitors had a similar level of accuracy to laboratory-based testing, Nice said.


The monitors would allow patients to measure the time it took their blood to clot "almost instantly" and then either contact a healthcare professional for advice or adjust the dosage of their medication themselves based on an agreed care protocol, it added.


Staying out of hospital

Nice said using coagulameters could reduce the frequency of visits to hospitals or anticoagulation clinics and allow the clotting tendency of patients to be monitored more regularly. This could reduce the risk of heart attacks and strokes by enabling the dose of therapy to be adjusted more accurately, it said.


Professor Carole Longson, director of Nice's health technology evaluation centre, said allowing patients to monitor themselves could also "reduce the anxiety" of waiting for results and give them "a sense of control".


In June, Nice advised prescribers to consider new anticoagulants as an alternative to aspirin when treating patients with atrial fibrillation.


Would you feel happy recommending self-monitoring devices to your patients?

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3 Comments

Chris Maguire, Community pharmacist

This is not going to happen through community pharmacy.
1) the cost of the NCAT training in Birmingham would be prohibitive to chains to get the number of pharmacists through
2) each community pharmacy would need CDSS software to help with dose recommendation which again is extremely pricey
3) when they say ring a health care professional they mean an anticoagulant pharmacist within a gp practice or within a local anticoagulation service that the patient will be giving their results too on a regular basis.
4) the only thing this is really suggesting is for community pharmacists to know if this is an option for your patients within your locality. Nothing more, nothing less. The sector is not educated enough at the moment for this to be a national service and the cost to make it happen means it is a non starter.

Meera Sharma, Community pharmacist

"The monitors would allow patients to measure the time it took their blood to clot "almost instantly" and then either contact a healthcare professional for advice or adjust the dosage of their medication themselves based on an agreed care protocol, it added"

So chances are very high that a patient will carry out the test and then contact the pharmacist to speak to them (increased queries), or turn up in the pharmacy because their coaguchek is not working, or ask for advise when they've adjusted the dose wrongly. Who's paying for all this extra workload? As mentioned before, there is a lot pharmacists CAN do, plan it and fund it better so that it's integrated healthcare, not random, piecemeal services.

N O, Pharmaceutical Adviser

Why we spend so much Money in NICE to complicate matters. Spend the money in a Community based Near To Patient INR testing, which has been proven to be very successful and cost saving. If the patient needs dose adjustment then the Pharmacist can advice on the spot or even prescribe under the PGD.

Lets look at the patient's perspective. 80% or more of these eligible patients are either pensioners or don't pay for their prescriptions. So why would they buy a testing equipment? Who will pay for the testing strips?

If this was found to be so efficient and could save hospital admissions then 1) why only few CCGs why not a national scheme? 2) again will it not be cheaper and more convenient with absolute clinical safety to provide this through a Pharmacy than the patients.

Lets say this is compared with the Glucose monitoring, then is it not going to be an expensive affair for the CCGs & the GPs, as the strips are not cheap either + the solution. Do they (NICE) not consider undertaking a cost analysis on a broader perspective before deciding on such schemes?

Once again the sector is neglected when a vital service can save money for NHS and been advised to provide free information to patients (taking lot of time) amounting to a free service. I am sure there will be many of our leaders lauding this decision from NICE and encourage all Pharmacists to actively promote the FREE SCHEME.

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