Anticoagulant therapy — self-treatment from home

Denmark Distance treatment

A self-monitored ac-treatment has been used in Denmark since the mid 90’s and is offered in 8 different centres all over the country. If patients are going to be treated with anticoagulant (AC) therapy for more than a year, the anticoagulant therapy centre (AC Centre) can offer patients training in handling their treatment themselves, at home. After the training, the patient must continue to work with the AC Centre and have follow-ups with a nurse. The health care staff will regularly review the patient’s AC treatment and the centre will be available with guidance on the treatment.

Patients will no longer have to go to the AC Centre many times a year to get treated, which reduces costs and time spent for both patient and health professionals. The solution enables patients to live their life as normal as possible. The patients get treated better than they normally would because they become experts on their treatment and symptoms.

The solution can be used for patients who require AC therapy for more than a year, and for patients that are considered suitable to take care of their own treatment. The solution shall not be used for fragile patients as it might cause them to get a worse treatment than they otherwise would.

Quotes/testimonials

“Due to the autonomous treatment, I experience myself as 100% healthy, although I believe that I am extremely aware of my treatment and my heart valve. It's just not a problem, just a life condition that I don't even think I would have been without.”

- Patient

Elaboration

Needs and challenges

Patients in need of anticoagulant therapy will frequently have to measure their blood clotting time and regulate their medicine dose at the hospital.

Many of these patients can as easily do this at home and reduce time spent going to the hospital.

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Solution and function

This solution offers self-monitoring and self-treatment so that patients capable of self-monitoring and self-treatment can get treated at home.

Self-management means that:

Patients take a blood sample from their fingertip and measure the blood clotting time (expressed in INR) on a device received from the AC Centre. The device is called a coagulometer.
Patients regulate their medicine dose and contact the AC Centre if in doubt about the dosage.
Patients submit the information about their AC treatment to the AC Centre.

When patients monitor their treatment at home they do not have to go to the hospital, they only have to go to the doctor to get new prescriptions.

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Implementation

The AC treatment is supported by both the national and regional digital health strategy.

The self-monitored ac-treatment has been used in Denmark since the mid 90’s and is offered in 8 different centres all over the country.

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Economy

Many of the usual meetings will be reduced. This has a great economic impact for the AC centres and to a great extend for the patients as well who will save time travelling to the centres. There may be costs related to training the patients, but this time will be reduced later on.

As the self-treatment is more accurate it means that less patients will experience fluctuations that can result in hospitalizations, which is both inconvenient and expensive, not to mention very unpleasant for the patient.

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Process

The patient will be thoroughly examined before entering the remote treatment, as it is very important that the patients are suited for self-treatment. Every course of treatment will be agreed upon by health staff and the patient to ensure that the treatment is individually adjusted for every single patient.

The workflow for the health staff changes as they will only see the patients for follow-up meetings, at least four times a year and not for regular treatment meetings.

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Follow-up/monitoring

The patient will do the measurements and control the medicine dose. If they have any questions or doubts about their treatment, they can always contact the AC Centre. The AC Centre will assess the measurements and contact the patient if they have any questions or advise for the treatment.

At minimum every 12 weeks the patient will have to give information about the number of tablets left, the weekly INR value, and comments about fluctuations, and nurses will go through the treatment at least 4 times every year.

The patient will submit the measuring device to the AC Centre for control when told.

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Communication

The patient will call the AC Centre when in doubt about anything and the health staff can call the patient if they find that the results are unusual.

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More about effects

Giving patients the possibility of self-treatment will change the workflow and workload for the health staff, enabling them to spend more time on the patients in need of it.

The patients will receive a better treatment and spend less time getting so, which release time to spend on other activities which can increase the quality of life.

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