Using IT to Improve
    Warfarin Management
      in the Hutt Valley

                Dr Garry Brown (Clinical Director) &...
Primary Health Care Strategy
..................................................................
   • Co-ordinate care acro...
Warfarin is a High Risk Drug
..................................................................
   • Levels measured by In...
Lowest Effective Intensity for Warfarin Therapy for
       Maintenance Therapy
           Stroke Prevention in Atrial Fibr...
The Solution
..................................................................




               The Solution
.............
The Solution
..................................................................
     • Hutt Valley
       DHB and
       C...
The Solution
..................................................................
     • Hutt
       Valley
       DHB
     ...
The Solution
..................................................................
     • Aotea Pathology defaulters database...
The Solution
..................................................................
     • Sample of
       fax sent
       to...
The Future
..................................................................
     • Dealing with patients who have no GP
...
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Using IT to Improve Warfarin Management in the Hutt Valley

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Dr Garry Brown & Richard Kelly
Kowhai Health Trust

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Using IT to Improve Warfarin Management in the Hutt Valley

  1. 1. Using IT to Improve Warfarin Management in the Hutt Valley Dr Garry Brown (Clinical Director) & Richard Kelly (IT Specialist) www.kowhaihealth.org.nz Friday, 16th March 2007 In a nutshell… .................................................................. • Warfarin is one of the 5 highest risk drugs in clinical use • Management of warfarin is highly complex Significant sources of avoidable error arise from – information flow issues from secondary to primary care – practice system issues – patient compliance issues • Use the power of IT, and the principles of the Primary Health Care Strategy to improve system wide management of warfarin patients 1
  2. 2. Primary Health Care Strategy .................................................................. • Co-ordinate care across service areas • Offer access to comprehensive services • Continuously improve quality using good information • Identify and remove inequalities • Develop the primary care workforce • Work with local communities Warfarin is a High Risk Drug .................................................................. 2
  3. 3. Warfarin is a High Risk Drug .................................................................. • Levels measured by International Normalised Ratio (INR) • Levels too low lead to excess blood clotting eg embolic stroke, DVT • Levels too high lead to excess bleeding problems eg haemorrhagic stroke, GI bleeding Maintenance Therapy Risk of Intracranial Hemorrhage in Outpatients Adapted from: Hylek EM, Singer DE, Ann Int Med 1994;120:897 -902 Hylek, et al, studied the risk of intracranial hemorrhage in out patients treated with warfarin. They determined that an intensity of anticoagulation expressed as a p rothrombin time ratio (PTR) above 2.0 (roughly corresponding to an INR of 3.7 to 4.3) resulted in an increase in the risk of bleeding. 3
  4. 4. Lowest Effective Intensity for Warfarin Therapy for Maintenance Therapy Stroke Prevention in Atrial Fibrillation INR below 2.0 results in a higher risk of stroke Hylek EM, et al. NEJM 1996;335:540 -546. -546. Whose problem is it? .................................................................. . 4
  5. 5. The Solution .................................................................. The Solution .................................................................. • Address information flow issues via Concerto, Healthlink • Address practice system issues using MedTech template, and additional education and knowledge resources • Address patient compliance issues using Patient Defaulters database from Aotea Pathology 5
  6. 6. The Solution .................................................................. • Hutt Valley DHB and Concerto The Solution .................................................................. 6
  7. 7. The Solution .................................................................. • Hutt Valley DHB Discharge summary The Solution .................................................................. • MedTech screening template (at GP Practice) 7
  8. 8. The Solution .................................................................. • Aotea Pathology defaulters database The Solution .................................................................. 8
  9. 9. The Solution .................................................................. • Sample of fax sent to Practices with details of their defaulting patients Results .................................................................. • Reduction in patients defaulting for INR testing from 8.3 % down to <3% of all patients (1200 in Hutt Valley area) • Reliable, accurate, complete, and timely flow of critical clinical information from hospital to primary care • Improved practice systems using MedTech templates 9
  10. 10. The Future .................................................................. • Dealing with patients who have no GP • Can we extend this systems approach for other high risk drugs eg: amiodarone > a pilot is in progress • Text/email patient INR test reminders • Linking to Point of Care testing • Using Web hosted decision support tools > in development by BPAC 10
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