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Letters to the Editor
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Near patient testing
Sharing experiences
From Dr B. Waring, MRPharmS, and others
We would like to congratulate Coleman et al (PDF 70K) on their
pilot study of a community pharmacy run anticoagulation clinic (PJ,
4 December 2004, pp822–4) and share our experiences at Sheffield
South East Primary Care Trust.
We currently have 10 GP practices involved in a near patient anticoagulation
testing (NPAT) service. By April 2005 we aim to be managing the anticoagulation
for approximately 700 patients in primary care and have 14 accredited
anticoagulation practitioners.
A variety of models are being used which reflect the diversity and need
for flexibility in the primary care setting. The clinics range from established
NPAT clinics to those in their infancy. The anticoagulation practitioners
include community pharmacists, a practice-based pharmacist, practice
and district nurses and a GP. Several of our clinics have trained health
care assistants to use the CoaguChek machine so that housebound patients
can also benefit from the more localised service.
Our community pharmacy anticoagulation service currently manages 25 warfarin
patients attached to three GP practices and aims to take over the care
of another 25 patients soon. The clinic is run on a set morning each
week when the pharmacy is staffed by two trained anticoagulation pharmacists.
Written dosing information is communicated to the GP as well as the patient.
Close liaison and discussion with secondary care anticoagulation practitioners
has been essential for the development of this service. Input from the
local consultant haematologist has been crucial for development of standard
operating procedures and clinical guidelines, and liaison with secondary
care anticoagulation clinics is vital for the safe and appropriate transfer
of patients from secondary care into primary care management. Developing
links with anticoagulation co-ordinators from neighbouring PCTs has also
been useful for sharing experience and workload.
We believe our primary care-based NPAT clinics will benefit patients
through greater access and regular interaction with a health care professional
and that their anticoagulation management should improve through greater
understanding, as well as having the advantage of being a more localised
service. Patient feedback so far has been positive but plans for early
2005 include a patient satisfaction survey as part of the service evaluation.
Future work will include feasibility testing for the expansion of the
NPAT services through the PCT. Financial constraints may mean that for
smaller GP practices a more viable option would be to provide a central
but local service and a community pharmacy may be ideally placed to provide
this service. With the new pharmacy contract and supplementary prescribing,
remuneration and support for this process is in place and the potential
for pharmacists to expand their role is there for the taking again.
Brigitte Waring
Clinical Practice and Anticoagulation Lead Pharmacist
Sheffield SE PCT
Tina Cooke
Vantage Pharmacy
Sheffield
Steve Morris
Director of Primary Care and Chief Pharmacist
Sheffield SE PCT |
The
Pharmaceutical Journal