INR monitoring shifting from the laboratory to the patient’s home

Published 24.03.2017
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INR monitoring shifting from the
laboratory to the patient’s home

According to Tuukka Helin, Specializing Physician at HUSLAB, more than half of those patients who take warfarin could qualify for self-care, meaning that the patients themselves use a point-of-care device to measure their INR (international normalized ratio) value and administer warfarin independently.

Helin talked about the topic at the Labquality Days event in Helsinki on February 9, 2017.
Warfarin is the most commonly used anticoagulant taken orally. An estimated 1.8% of Finns are on warfarin.

The drug metabolism in the body varies widely by individual and is affected by factors such as diet, smoking and alcohol consumption. Therefore, the treatment requires regular laboratory monitoring of blood INR values.

– It is very difficult, if not impossible, to predict the right dose of warfarin for a patient before treatment starts, Helin points out.

When the warfarin dose is adjusted, it will take several days before its full effects can be seen. Therefore, the principle has been that a physician should always be responsible for determining the correct dose.

However, in recent years, self-care of patients who take warfarin has been successfully piloted in several European countries. Patients receive relevant training, after which they perform INR tests and administer warfarin independently at home.

– Studies have shown that self-care with warfarin is at least as safe and efficient as the treatment provided by professionals, Helin says.

Good experiences from the pilot project

The Helsinki and Uusimaa Hospital District carried out a self-care pilot project with warfarin in 2014–2016 as a joint project between the HUS Coagulation Disorder Unit and HUSLAB.
The objective was to pilot an operating model for self-care with warfarin for application in both specialized medical care and basic health care. Now the operating model is being filtered down to all municipalities within the HUS region and to other hospital districts as well in the future.

– The pilot project included 50 patients and the results were good. In a patient survey, 95% of respondents indicated that they were satisfied with warfarin self-care, Tuukka Helin says.

At the initial appointment, the patient meets a physician and a nurse, who will assess the patient’s suitability for self-care monitoring. The patient should have the required motivation to implement self-care, remember to keep track of their treatment level actively, and commit to taking good care of the point-of-care device. The patient must also not have any conditions that could compromise self-care, including substance abuse or cognitive or motoric issues.

Those patients deemed suitable for self-care are trained to use the point-of-care device and to administer warfarin independently. The functioning of the point-of-care device is verified by means of parallel tests carried out in the laboratory.
As treatment progresses, the quality of point-of-care tests is ensured by frequent parallel tests as well as by the device manufacturer’s and Labquality’s control tests.

Self-care provides savings and improves treatment outcomes

Tuukka Helin believes that, when implemented properly, healthcare that engages patients supports the patients’ life management skills and improves treatment outcomes.

– When patients become active participants, they will understand their illness better and know how and when to seek help, if there are problems with the treatment, he says.

In the future, the importance of self-care will increase, as the population ages and services continue to centralize in larger and larger units.

– According to my own vision, the majority of patients who are on warfarin will be included in self-care monitoring in the future, thus significantly reducing the burden to the healthcare system, Helin summarizes.

Text and photo: Virpi Ekholm

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