Health Call's INR device

Health Call’s self-testing service for patients who take anticoagulation medication is rapidly expanding across the North of England. The new deal, being supported by NHSX means that over 2,400 patients in Newcastle upon Tyne and Yorkshire will be able to self-test their blood and interact with their clinical teams remotely.

City Health Care Partnership (CIC), Bradford Teaching Hospitals NHS Foundation Trust, Mid Yorkshire Hospitals NHS Trust, Airedale NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Foundation Trust will share the allocation of patients.

Patients will be provided with support, training and equipment so they can safely self-test at home. As part of the deal, they will receive a portable self-testing meter (CoaguChek® XS system) that uses a small finger prick blood sample; this provides an INR reading which is required to calculate their medication dose. The result is recorded on an app and sent directly to their anticoagulation clinic. A healthcare professional will then assess the result and send an automated notification back to the patient to inform them of their next dosing schedule. The data captured is integrated into the patient’s record.

Tara Donnelly, Chief Digital Officer, NHSX, said: “Through the pandemic at NHSX, we have been helping scale new technology that allows clinicians to monitor and assess patients’ conditions remotely. As part of our Innovation Collaborative, NHSX is delighted to be working in partnership with innovators and teams that are transforming care for thousands of people.

“Now more patients in Newcastle upon Tyne and Yorkshire will be able to self-test, making it quicker and easier for clinicians to monitor them remotely.”

The service was initially developed in partnership with County Durham and Darlington NHS Foundation Trust (CDDFT) and has transformed the lives of patients who take anticoagulant medication such as warfarin.  Anticoagulant medicines are routinely prescribed for people who have atrial fibrillation and are at increased risk of having a stroke. Anticoagulants are also used to treat other conditions, including deep vein thrombosis, pulmonary embolism and heart attack.

Typically, patients receiving warfarin, will need to regularly attend a healthcare setting – possibly once or twice a week – to have their INR level checked. Here, the healthcare professional will determine, based on the patients INR levels, whether the warfarin dosage is optimal or whether any adjustments need to be made.

Over 500 patients at the trust currently use the remote service. They are specially selected by trained staff and closely monitored. Steve Clarke from Chester le Street, one of the patients on the service said: “Self-testing is a very simple and easy process. Having to attend warfarin clinic several times a month had become a real chore and was challenging to my lifestyle. I used to find it stressful leaving work at lunchtime, driving through traffic and finding a parking space at the clinic and then rushing back afterwards.”

“Self-testing makes life much easier for me. It gives me control. I can test myself at home, work and on holiday. My time spent in ideal therapeutic range has increased dramatically. Although there is less face-to-face contact with clinicians, I am in regular contact with them and sometimes think they know me better than I know myself!”

Tracy Murphy, sister at CDDFT said: “The system is optional, although enthusiasm for it is very high amongst our patients. Primarily because it is much more convenient using this way, even for people who might not have access to smartphones or the internet.”

Ian Dove, director of Health Call, said: “We are delighted to be able to expand the self-testing service beyond County Durham. It has been extensively evaluated so we know the benefits that patients and staff find using the service. Patients love it because it is much more convenient. We also know from the evaluation that it helps them better manage their condition as over 70 per cent of patients improved their time in therapeutic range by 20 per cent. Plus, a 24-month follow up showed that this change is long lasting.”

The knowledge and experience of the team at Health Call and CDDFT is being shared with the new sites, including how to successfully identify appropriate patients, train and on-board them to the remote service.

Ian said: “We learnt a great deal from the initial projects in County Durham, so as part of this wider roll out of the service, we are sharing documentation, but most importantly the staff expertise who worked on this to help ensure that the new sites can get the most benefit from remote monitoring.”

Lord Bethell, Minister for Innovation, said: “We have scaled up the way we use technology at an incredible pace throughout the pandemic, taking seismic leaps towards home-testing and consumer diagnostics. “This initiative will make it more accessible, user-friendly and convenient for people to manage conditions remotely. By saving clinicians valuable time, the quality of care patients receive will ultimately improve.”