Anticoagulation self-testing to launch in Sheffield community pharmacies
A pilot project to move anticoagulation testing from secondary care to community pharmacies is about to start in Sheffield.
The project involves patients self-testing, but doing this in a pharmacy.
The idea for the scheme came from Andrew Hartley, a community pharmacist
in Sheffield who sits on both the local pharmaceutical committee and
the professional executive committee of the primary care trust in south
west Sheffield. “Secondary care has got a crisis with no capacity
to deal with the growing number of people who need monitoring,” he
told The Journal.
Patients will use CoaguChek S testing machines in community pharmacies
to measure INR levels |
The pilot will take place in five community pharmacies. Both pharmacists
and pharmacy staff have been trained so that they can assist patients
who are carrying out the tests. The pharmacies have been supplied with
CoaguChek S machines and other material, such as laminated reminder cards
to which patients can refer.
To participate, each pharmacy needs an area where a patient can sit and
carry out a test. But Mr Hartley stresses that various approaches to
this have been taken and it is not just for pharmacies that already had
consultation areas. For example, one pharmacy has put a testing area
into a back office that is separate from the dispensary.
When patients come for a test, they will be asked to fill in a form that
contains some questions about recent illness and changes to medicines
or supplements they are taking. The international normalised ratio (INR)
test result will be added to this form and the pharmacist faxes a copy
of it to the local surgery. The INR will also be recorded in the patient’s
yellow book (INR record). Pharmacists also have to carry out quality
assurance tests on the machine.
It is expected that each of the five pharmacies will see 50 patients
a month during the pilot. These 250 patients account for 21 per cent
of the total number of people requiring anticoagulation services in the
area: this is about the figure by which secondary care services in Sheffield
said they wanted their workload to be reduced. Looking to the future,
Mr Hartley said that capacity could be increased if the pilot is rolled
out. “The five sites could comfortably handle a couple of hundred
patients each,” he said.
Pharmacists in the pilot will be paid a professional fee of £4
per patient for each test, and are also given an additional sum, of around £25
each month, to cover the costs of using the space in the pharmacy. “This
project is extremely economic,” commented Mr Hartley.
Patients are currently being recruited to the pilot. Each of the pharmacies
has links with a local surgery, and patients are being identified at
these practices. A patient training session will be held in September
where pharmacists and pharmacy staff, working with Roche (the manufacturer
of the testing machine being used), will show patients how to self-test.
In the longer term, it is hoped that as new patients join the scheme,
they will be trained in the pharmacy. |
