Could your patients self-monitor their INR levels?
This information may help you with your decision to support patients who would like to self-monitor their INR using CoaguChek
This page is intended for healthcare professionals in the UK and Republic of Ireland
What is self-monitoring?
Self-monitoring is where a person on warfarin tests their INR themselves using their own portable meter, rather than having to attend a clinic at a GP surgery or Hospital. This is more convenient for the individual as it reduces the number of clinic visits required, saving on regular time away from work or home life. It requires only a small drop of blood from the finger and they report the result to their healthcare professional.
What is the difference between self-testing and self-management?
Self-monitoring is the collective term used to describe both self-testing and self-management. Self-testing is when an individual tests their INR themselves using the CoaguChek meter at an agreed time, and then reports that INR result to their healthcare professional so that you can advise and adjust the patient’s warfarin dose accordingly.
Self-management is when the patient can adjust their own warfarin dose after testing with the CoaguChek meter, within agreed limits. This is after you as the healthcare professional have provided training and an agreed protocol to follow.
Is self-monitoring safe?
A 2012 systematic review of data published in the Lancet showed that “…self-monitoring and self-management of oral anticoagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable healthcare support as back-up.” 1
Self-monitoring with CoaguChek is recommended by NICE2 for patients on long-term anticoagulation therapy
Is self-monitoring accurate?
Yes, the CoaguChek meter has a number of built-in features to help ensure the accuracy of results. These include a check to ensure the blood has been correctly applied plus built-in controls on the meter and in the test strip. The INR result will only be displayed once these checks have been successfully passed.
The CoaguChek® XS has been independently evaluated and approved. It has an ISI of 1.02, as recommended by WHO3 and the British Society of Haematology, for results that closely correlate with clinical methods, and a CV of 4.5 per cent.3
Details on Calibration & QC on the machine:
The CoaguChek meter has a number of inbuilt system checks. For details, please refer to the meter manual (current V3). The test strip has an integrated quality control function. Quality control and system checks with test fluids as used in certain other systems are not required on the CoaguChek XS meter.
It is recommended that a side by side test of the patient meter with a clinic-based CoaguChek device is conducted every 6 or 12 months. Specific frequency of side by side testing is a local clinic decision.
What are the clinical benefits of patients self-monitoring?
When you compare INR monitoring in an anticoagulation clinic or in primary care, self-monitoring:
- Helps the individual to keep their INR in their therapeutic range.1
- Reduces the risk of thromboembolic events by 49% based on one systematic review and meta-analysis.1
- For people, younger than 55 years, the likelihood of developing thromboembolic events was reduced by two-thirds, and for patients with a mechanical heart valve, the risk was halved.1
- Lowers mortality, whilst not increasing complications in people aged 85 and older, who are at high risk of major bleeding, which suggests that age should not be a factor in determining eligibility for self-management1
How does self-monitoring fit in with patient-centred NHS outcomes?
Self-monitoring supports a patient-centred NHS by enhancing the quality of life for people with long term conditions and can improve the quality of patient oral anticoagulation therapy when compared to standard monitoring.5
There are also Digital Health options available, associated with self-monitoring of INR. You can learn more here.
Self-monitoring may enhance the quality of life for people who are:
- Frequently away from home
- In employment or education
- Wish to travel or enjoy time away from the clinic
- Unable to travel to clinics6
Ensures that people have a positive experience of care:
- Based on one study, 77% of people preferred self-monitoring to the usual model of care7
- Fewer consultations and hospital admissions are required when self-monitoring8
What are the guidelines on self-monitoring?
NICE recommends considering self-monitoring if the patient would prefer it and certain conditions are met.9
Your patients should only begin self-monitoring with your support. They can buy the CoaguChek meter themselves, with the test strips available via an FP10.
They will need training on how to self-monitor, ongoing support and review. NICE recommends that they are reviewed at least every six months, and have access to an appropriately trained healthcare professional for advice when they need it. Educating patients in self-monitoring is essential to ensure that they adhere to your agreed testing schedule.
Roche provides a support and training service for patients, and for healthcare professionals interested in supporting their patients self-monitor. For more information, call our Freephone Care Line on 0808 100 7666 or contact us at firstname.lastname@example.org. This website contains further resources and you can learn more about the training support offered on the Training page.