communicate local clinical service information
Anticoagulants are prescribed for certain medical conditions where the patient’s blood clotting time needs to be increased so as to prevent clots from forming. It is a high risk service with potentially adverse outcomes if the patients are not closely monitored.
Newham Local Healthcare Community (LHC) redesigned the care pathway by developing and providing a Point of Care Testing service in primary care for stable patients requiring anticoagulation. The pathway aimed to improve the management of patients receiving anticoagulation drugs and reduce the number of patients developing complications, improving patient safety.
Role of Map of Medicine
Newham LHC uses the Map of Medicine as the system of choice for receiving, understanding and following guidelines, services and referral criteria as specified in the localised pathway. The existing anticoagulation pathways were adapted on the Map of Medicine with local clinical service information and guidelines.
Milestones
- The primary care pathway for mobile patients was developed first. Activity data and costs were analysed to establish the need and necessity of the redesign, including future capacity requirements.
- Clinics were visited to gain insight of the patient flow and patient opinion.
- Primary care anticoagulation service specifications were developed.
- The draft specifications were widely circulated to the GPs, the local medical and pharmaceutical committees and Practice based Commissioners.
- Providers were selected and trained.
- The new pathway was designed,developed and made available in the Map of Medicine, allowing it be easily communicated to providers.
Challenges
- Primary care pathways for housebound patients and those requiring transport impacted multiple stakeholder groups, some of which were difficult to engage with.
Results
The redesign of the care pathway has resulted in a Point of Care Testing service for stable patients in primary, rather than secondary, care. With 25 clinics available, 33% of patients are now being managed at this level, improving access for patients and saving Newham LHC approximately £300,000 for 2009/10, and up to £500,000 in 2010/11.
The number of referrals from primary to secondary care for monitoring almost halved and the percentage of patients within the correct limits increased in the months after the pathway was implemented. The risk to patients has decreased and 96% of patient respondents said that the new service was an improvement on the previous one.