Anticoagulation in primary care
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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

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ANTICOAGULATION IN PRIMARY CARE

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ANTICOAGULATION IN PRIMARY CARE

The Sea-Urchin Model !


Who am I ?

Dave Bottoms, Pathology Services Manager

South Durham Health Care

Teespath IT Project Manager


THEHUMBLE 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

  • Patient Access – closer to home

  • Less delay

  • Less hurried appointments

  • ? More flexibility on dates

  • ? Clinician better briefed on holistic care

  • ? One-stop visit


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


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)


PRIMARY CARE OPTIONS

Option : Urchin

Benefits

Retention of centralised database

Affordable

No staff travel required

Far less risk with no-risk potential

Drawbacks

?


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


Teespath Projects

  • Anticoagulant Dosing in Primary Care

  • Lab to Lab Links

  • Anglia ICE Requesting

  • Better Blood Transfusion

  • Telepathology

  • Document Management


THE HOSPITALS

Durham

Hartlepool

Bishop Auckland

N Tees

S Tees

Darlington

North Yorks Moors

Northallerton


HOSPITAL CATCHMENTS

AN IDEALISTS VIEW

Durham

Hartlepool

Bishop Auckland

N Tees

S Tees

Darlington

North Yorks Moors

Northallerton


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


RESULT AVAILABILITY

Mental Health

Cancer Centre(s)

Primary Care

Tertiary Care / Referral Labs

DMH

NursingHomes

HA


OUR PRIMARY CARE SECTORS

The Dales PCT

Sedgefield PCT

Darlington Memorial Hospital

Darlington PCT


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


Hartlepool

BAGH

  • Reduce Clinic Overload

  • Improved patient access

  • Standardise dosing procedures

Shildon

N Tees

DMH

S Tees

Friarage


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