Modello organizzativo di gestione decentrata della terapia anticoagulante orale nella ULSS 6 Euganea
Organisational model for the local management of oral anticoagulant therapy in the “ULSS 6 Euganea”.

AUTORI

ABSTRACT

Organisational model for the local management of oral anticoagulant therapy in the “ULSS 6 Euganea”.

Introduction: Point of Care portable coagulometers (POCT-INR) allow to shift determination of prothrombin time (PT-INR) from central laboratory to local health facilities. In a broad and complex territory, determining PT-INR in decentralized offices is a key objective for the monitoring of the therapy and patient’s life quality improvement. Aim of the study is the description of the organizational model for decentralized management of patients in Oral Anticoagulant Therapy. Methods: starting from October 2020, a bidirectional connection was implemented between Laboratory Information System (LIS) of the Ospedali Riuniti Padova Sud “Madre Teresa di Calcutta” Monselice (Padova, Italy) and peripheral offices, where clinical data are collected and PT-INR determined by POCT-INR (by Coaguchek® Roche Diagnostics, Germany). Results are sent in real time to central laboratory where data are validated and stored. Data can be consulted and downloaded like any other laboratory test. Results: the project involved 2 980 patients. Peripheral centres are located throughout the territory of ULSS 6 Euganea, with 81 POCT-INR instruments for around 60 000 determinations per year with an average of 7.4 INR measurement per patient. Around 2% of these INR showed a value >5 (critical value) and have been immediately communicated by the POCT manager to the physician in charge of the therapy. For two patients with polycytemia vera it was impossible to have an INR value measured by the POCT because of the high value of the hematocrit and a venous blood collection was necessary. The POCT instruments analytical performances are verified by the POCT manager, using an internal quality control program; regular reports are sent to the pertinent local facility. Conclusions: the connection with LIS represents the project’s focal point, allowing data storage, making them available at any time for any connected facility. This model simplifies the management of patients allowing easier access to the determination of PT-INR, with more constant therapy control and significant improvement of the patients’ quality of life without jeopardizing the patients’ safety.

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