Improving Anticoagulation Management at the Point of Care-POC
1.Of all the existing pharmaceutical therapies at present, the category of coumarin anticoagulants such as warfarin representssome of the most difficult and dangerous drugs prescribed for the patients. (1)
2The Published studies describes the risk of major bleeding( or)thromboembolic events due to warfarin therapy as between2-12 % per year.Inspite of high potential for severe side effects of warfarin and myriad drug interactions, physicians attempt therapeutic warfarin oversight without regular scheduled anticoagulation appointments. (1)
Patient-focused anticoagulation care(POC)
* 1.Larger practices & some of the health care systems can alleviate some of these common problems in the anticoagulation care by turning to
anticoagulation clinicsin order to arrange and manage the details of warfarin therapy. though smaller offices have infrequent access to such resources, they have no need to forgo their associated benefits. With this use of point-of-care (POC), CLIA-waived anticoagulation devices, provides anticoagulation assessment and warfarin
2.Using this, POC anticoagulation device returns physician attention to treat patients rather than the laboratory results and extends a physician control over the monitoring.
These are good considerations that are given the high-risk of disease states being treated (e.g., atrial fibrillation, cardiomyopathy) (1)
3.POC devices also allow anticoagulation management which is convenient for the patients and physicians. In a single office visit, the history is updated, a physical examination is performed and, with 1 fingerstick, INR is accurately measured. The entire care transaction will be completed in a fraction of time it would take to draw and process a blood sample following a traditional laboratory format.(1)
POINT-OF-CARE ANTICOAGULATION DEVICES
These easy-to-use devices return the focus of warfarin therapy to treating the patient.
1.Family practice offices usually use CLIA-waived laboratory monitoring devices inorder to assess the
pregnancy status, lipid disorders, streptococcal and helicobacter infections. Recently, coagulation monitors have joined repertoire of fast and reliable outpatient monitoring devices.(2)
2.CLIA-waived devices, CoaguChek and ProTime, are currently mostly available for testing the whole blood for prothrombin time/International Normalized Ratio . The staff training time for both the devices is typically less than 1 hour. In fact, because of their ease to use, the FDA has approved them for patients to use at home.
The devices use thromboplastin reagents packaged in the strips or "cuvettes" similar to those used in the blood-glucose testing systems. Both systems have the sensors that prevent results from being reported if there is an error in sample collection timing, vibration or temperature extremes. Test results are available in 2-5 minutes.(2)
* 3.POC devices also allow for the patient-focused anticoagulation care i.e.., POC care that includes the reviews of warfarin compliance and its side effects, medication
and dietary changes too, and disease-state management goals. For instance, the
most common indication for warfarin therapy is to prevent the stroke in patients with atrial fibrillation. Point-of-care anticoagulation assessment will allow you to concurrently address other factors that contribute to stroke risk (like hypertension and hyperlipidemia).(2)
1.http://www.aafp.org/fpm/2002/0200/p35.html (ACCESSED ON 30TH SEPTEMBER:9:30P.M)
2.http://www.anthem.com/medicalpolicies/guidelines/gl_pw_a053674.htm(ACCESSED ON 30TH SEPTEMBER:9:30P.M)
(ACCESSED ON 30TH SEPTEMBER:9:30P.M)
(ACCESSED ON 30TH SEPTEMBER:9:30P.M)
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