The Pharmaceutical Journal
Vol 271 No 7267 p367
20 September 2003

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  Pharmaceutical Press
  EpiPen
  Self-testing
  CPD

Letters to the Editor

Self-testing

A reliable and reassuring facility

From Mr D. J. Morl, MRPharmS

The initiative of Andrew Harvey and other pharmacists in the Sheffield area in starting a controlled “in-pharmacy” pilot study of international normalised ratio self-testing (PJ, 16 August, p197) is to be applauded. It is clearly the case that there is considerable variation in the confidence levels demonstrated by medical and other health professionals towards the wider use of the CoaguChek machine and its reliability in the hands of the patient. It is to be hoped that the research, now beginning in Sheffield, will give a clear lead on the usefulness of the patient taking a responsible role in the management of their own condition and their ability to take regular readings of INR values. This should prove to be of considerable value at times when INR estimations show quite wide changes for no obvious reason and could alert the patient to seek medical advice should a repeat test gave a similarly wild result.

My consultant at the Royal Brompton Hospital, nearing three years ago, drew my attention to the CoaguChek machine and its application. Following a “cardiac event” I had been put on to a regimen of treatment which included warfarin and routine hospital appointments to keep a watchful eye on my INR. My wife and I had planned a wide-ranging tour across the world and as parts of the world that we would be visiting did not thrill me with the thought of having needles stuck into me I asked what was the alternative? He arranged for me to have an introduction to the equipment and as a result I purchased a machine.

After having undertaken the trip without having to report to hospital for INR investigation it gave me confidence to continue as I have done for this past three years.

My GP has made it quite clear that he does not wish me to stop attending clinic and does not believe that he can adequately manage his anticoagulant patients on home testing alone. I agree with that outlook but I am sure self-testing does mean that I should not have to visit hospital so often and waste hours of staff time as well as my own. It would seem a better use of time and finance, if a visit to the hospital was initiated by the patient, his pharmacist, or his GP when it was necessary.

Even though I still have to finance my use of the strips I will carry on with what I believe to be a reliable and reassuring facility and, who knows, perhaps one day I might persuade my GP to put the strips on a prescription for me!

D. J. Morl
Chelmsford, Essex

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