Some of you may recall that I have posted on here moans about the INR testing facilities offered by my GP's practice here in Cornwall.
To recap - I was diagnosed with AF by East Surrey Hospital in January 2010 and after 6 days of diagnosis, monitoring, a variety of tests and warfarinising I was released to the care of my GP in Dorking, Surrey.
My Dorking GP's practice performed INR testing using the Coaguchek XS system and did so long before the NICE Guidelines DG14 were published. The practice nurses administered the INR testing process and results were provided on the spot by the practice computer within minutes. The results recorded the INR at the time, next dose and the next test date. Simples.
Fast forward to August 2012 - on arrival at my new home near Hayle in Cornwall I registered with a medical practice within 5 minutes walk away. Almost immediately on arrival in Cornwall I was due for an INR test. I was rather surprised to be introduced to the Venous Draw technique – I just assumed that the Coaguchek system was universal. I accepted the Venous Draw initially as time was not a problem, however, it became quite disruptive as I had obtained employment. The new practice only conducted INR's on a Thursday, sent the blood sample away that day and phoned the results to me the next day. As I was and still am stable on Warfarin I decided to 'go with the flow' and see what happened. By mid 2014 my working hours had increased and it was now becoming quite difficult to keep appointments.
At this point it needs to be said that for every Venous Draw reading that was taken I carried out my own reading with my own Coaguchek XS device as a cross check as to what was happening. The readings using the two different methodologies rarely produced the same result, however, there was always a very strong correlation. I also travelled to Australia and found the practice willing to prescribe me the Coaguchek XS test strips. I also have to say that twice – as a result – of using my Coaguchek device to cross check the Venous Draw method I had to contact my GP and ask for a review of the doses which to me seemed in error. Twice I got an apology and an amended dose. I put up with this arrangement until November 2014 when I was notified that my working hours would be increasing again in early 2015.
I contacted both my local GP and CCG, referred to NICE Guidelines DG14 and sought their blessing on using my Coaguchek device. Well, I got the run around from the CCG and after an initial contact from the Business Manager of my GP practice it all went dead quiet. Some 10 weeks have now passed.
I then did a search on the internet and found another GP practice in Hayle and telephoned them and asked if they had an INR Clinic which used the Coaguchek device. They did as it happened and I asked if I could register with them. I was invited to a meeting with a GP and the senior INR Nurse. Had a FAQ type discussion with them which seemed to focus on my history with Warfarin, why I was put on it, why didn't I switch to the NOAC's, what is the NICE recommended INR testing frequency, what are the benefits of self monitoring, what QC systems are in place in respect of using the Coaguchek device, and why did I want to register with their practice. Some time was also spent discussing my medical history and some time was spent discussing the concerns of the practice about users of the Coaguchek system, i.e. some patients using the Coaguchek XS system are obsessed with testing and were costing the practice a 'mint' by testing at needlessly frequent intervals. If I were one of those it may be cheaper for the practice to prescribe NOAC's. I stated that I am not one of those and in any case I would not use NOAC's as they have no antidote at this stage.
Eventually the GP agreed the practice would accept me, I was duly registered and it was agreed I'd stay on Warfarin. So now I am with a practice that operates exactly as my practice in Dorking, Surrey and I can return to living a relatively stress free life as I no longer have to present for Venous Draw INR blood tests. I have virtually all the freedoms I had before this bloody AF thingy hit me.
I was then passed over to the senior INR Nurse, with my Coaguchek device and with my records from the last two years of INR tests which she then entered into her computer system. We also cross checked the readings of the two Coaguchek devices, (her practice device and my own personal device) and the two gave exactly the same reading, using the same drop of blood. By good fortune the day all this occurred I was due for a INR blood test anyway, so everything was on schedule.
My next INR test is on 22 April and all I have to do is do my test at home, before going to work, phone it to the receptionist, confirm I have not missed any doses, or eaten 'forbidden fruit' (so to speak), the INR Nurse herself phones me back to confirm the reading and later rings me back with the result and next dose and confirms everything in writing by mail.
Then at every 10 tests I bring my own device in for a calibration check.
I was also taken on a journey through the repeat prescription process as it was significantly different to my previous Cornish practice and even compared to my previous Dorking, Surrey practice. That said, it is a much better process as I get the practice to manage my prescriptions on a 28 day basis and I just advise them those meds I do not want at the next prescription issue. Again – simples.
Apologies for the length of this, just thought some of you may be interested.