A self-testing pathway for patients receiving treatment for long-term heart conditions in north Manchester is said to have 'significantly' increased the quality of their therapy.
At the start of the project, the average time spent in therapeutic range (TTR) for the participating patients was 68%, rising to 75% when it concluded.
Evaluation found the pilot study reduced the chance of blood clotting and prevented at least five potential strokes among the group of 198 users. It also demonstrated the potential to save more than 3000 community outpatient appointment slots between May 2017 and October 2018, the period of evaluation.
The results have paved the way for the service to be rolled out more widely for eligible patients in Manchester who would like the health and lifestyle benefits of self-testing.
This was an NHS Manchester Health and Care Commissioning (MHCC)-led initiative in partnership with the Pennine Acute Hospitals NHS Trust, Health Innovation Manchester and Inhealthcare. MHCC originally commissioned the pilot and evaluation. Pennine's community anticoagulation monitoring service delivered the pathway and supported patients with training. Health Innovation Manchester led the evaluation and Inhealthcare, a UK leader in digital health and remote patient monitoring, enabled the self-testing pathway to be developed.
The self-testing pathway is for patients diagnosed with atrial fibrillation, deep vein thrombosis, pulmonary embolism or with a mechanical heart valve who are prescribed the anticoagulant drug warfarin. Previously, the patients attended a community or hospital clinic on a regular basis for blood tests to determine their correct dosage.
In the pilot study, patients tested themselves at home via a portable device which requires only a pinprick drop of blood. The patient sent in their results via a bluetooth mobile app, secure web portal or automated telephone call. Their dosage information and next test date were sent back via the same patient preference route.
Patients still had access to the anticoagulant telephone help and advice line should they have needed it.
Patients were selected according to criteria including good eyesight, mobility and dexterity to ensure responsiveness to the technology. Carers or family members were also trained to carry out the blood test if a patient was unable to do so.
Clinicians, commissioners and patients welcomed the findings. Dr Peter Elton, clinical director of the Greater Manchester, Lancashire and South Cumbria Strategy Clinical Network, said the results were “very heartening.”
He added: “The most effective form of anticoagulation is self-management, much more than novel anticoagulants on average. It is thought this is because of an improvement in TTR percentage. So any higher percentage leads to a greater reduction in blood-clotting events.”
Ben Bridgewater, chief executive of Health Innovation Manchester, said: “Our evaluation has demonstrated the effectiveness of this innovative self-testing service and highlighted the opportunity for it to be spread across Greater Manchester for the benefit of patients and clinicians.
“This powerful collaboration between the NHS, industry and academia shows how Greater Manchester is leading the way in the digitally-enabled delivery of health and social care.”
Patient Kathryn McDougall, a 70-year-old retired public sector manager from North Manchester, has been using the service for the last 18 months.
She said self-testing is convenient, flexible and allows her to go on holiday. She added: “I have the scope to check my own health and I have grown in confidence in my use of technology. This would have been great during my working life.”
Bryn Sage, chief executive at Inhealthcare, said: “Our technology allows people with long-term heart conditions to stay on top of their health without the hassle of inconvenient and time-consuming hospital or clinic appointments.
“This is exactly the sort of service that can reduce pressure on busy NHS clinics and allow staff to spend more time with patients who need care the most.
“We have rolled out similar services across England, Northern Ireland and Scotland and are delighted with the results of this evaluation in Manchester.
“The use of digital technology to provide convenient ways for patients to access advice and care is a central part of the NHS Long Term Plan.”