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

ANTICOAGULATION IN PRIMARY CARE

The Sea-Urchin Model !


Who am i

Who am I ?

Dave Bottoms, Pathology Services Manager

South Durham Health Care

Teespath IT Project Manager


Anticoagulation in primary care

THEHUMBLE SEA-URCHIN


Pressures on anticoagulation control services

Pressures on Anticoagulation Control Services

  • Too Many Patients

  • Overcrowding

  • Delays

  • Angry Patients

  • Stressed Staff

  • H&S Issues

  • Complaints

  • Mistakes

  • Litigation


Alternative solutions

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

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

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

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 options1

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 options2

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

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 options3

PRIMARY CARE OPTIONS

Option : Urchin

Benefits

Retention of centralised database

Affordable

No staff travel required

Far less risk with no-risk potential

Drawbacks

?


Anticoagulation in primary care

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

Teespath Projects

  • Anticoagulant Dosing in Primary Care

  • Lab to Lab Links

  • Anglia ICE Requesting

  • Better Blood Transfusion

  • Telepathology

  • Document Management


Anticoagulation in primary care

THE HOSPITALS

Durham

Hartlepool

Bishop Auckland

N Tees

S Tees

Darlington

North Yorks Moors

Northallerton


Anticoagulation in primary care

HOSPITAL CATCHMENTS

AN IDEALISTS VIEW

Durham

Hartlepool

Bishop Auckland

N Tees

S Tees

Darlington

North Yorks Moors

Northallerton


Anticoagulation in primary care

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


Anticoagulation in primary care

RESULT AVAILABILITY

Mental Health

Cancer Centre(s)

Primary Care

Tertiary Care / Referral Labs

DMH

NursingHomes

HA


Anticoagulation in primary care

OUR PRIMARY CARE SECTORS

The Dales PCT

Sedgefield PCT

Darlington Memorial Hospital

Darlington PCT


Anticoagulant dosage in primary care

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


Anticoagulation in primary care

Hartlepool

BAGH

  • Reduce Clinic Overload

  • Improved patient access

  • Standardise dosing procedures

Shildon

N Tees

DMH

S Tees

Friarage


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