Change to Call In Procedure

[Guest]

I called my coumadin clinic today because I'm starting crestor for my LDL(bad) cholesterol, it is at 160. My HDL (good) cholesterol is at 60. Triglycerides are 124, total cholesterol is 245, I've never been this high and it's genetics on my part.

I'm going to test in 3 days just to be sure, then call in an INR in 1 week as requested.

The coumadin clinic is changing procedures. Rather than me calling them when my INR is in range, and they return my call when I don't need any dosing changes, they will have either Tapestry Medical or QAS take my call in, and have Tapestry or QAS fax them a report monthly. Anytime I'm out of range, I would call the coumadin clinic. The coumadin clinic wants me to test weekly because she said studies show less risk of bleeding problems(I agree with this part). I told her I already test bi-weekly and call them when the coumadin clinic tells me to.

The coumadin clinic is going to coordinate all of this with Tapestry or QAS and call me with instructions going forward.

My question for those of you who call into QAS, do they charge for their services? What has your experience been? Does anyone call into Tapestry?, What has your experience been with them? Tapestry is where I get my supplies. Who manages your prescription from that point? Your doctor or QAS or Tapestry?

I always thought calling in my INR when I was in range with no changes to dosing and them calling me back to say "No changes" was silly and time consuming. I guess they are finally realizing the overhead costs and that the volume of home testers they manage is increasing (yay for home testers). They don't charge me for anything now, except when I have to go into the clinic which has not been for almost a year.

Thanks in advance for sharing your wisdom.

 

[Freddie]

I believe Crestor will interact with warfarin, so may want to keep a close watch on your INR.

 

[Blanche]

Better safe than sorry

Better safe than sorry

Louise:

I used to deal with doctors who only called when there were problems with my tests....and that was just fine for me. That is, that was fine until one time when I was not called and yet I had a very serious problem. They should have called but did not...heaven only knows why.

All of our doctors call us regardless of results..except one doctor. Everytime something is done to Al or to me, if they don't call I still need varification. I call them. For years, they told me...we only call when there is a problem. Well, that very same doctor is now dealing with a very bad problem with one of his patients. The patient should have been called and was not. Someone messed up and the call was not made...could happen in any busy doctor's office..

For me, the only way I am sure that all is well is that I receive a call from the doctors office saying so. I request to be called with results period, and then I request that they send me a copy of the test results.

Mistakes do happen.

Kind regards,
Blanche

 

[Cris N]

The cynical side of me wonders if there's something else going on. I heard somewhere that the dr office can't bill the ins. co for a PATIENT phone call- maybe they can if the call is from an outside agency calling ABOUT the patient- gets treated like a consultation. I don't know but anything's possible

 

[Guest]

I believe Crestor will interact with warfarin, so may want to keep a close watch on your INR.

Hi Freddie, Yes I checked for interactions between crestor and coumadin, that's why I will test in 3 days, then again next Wednesday. I have to call in next Wednesday's read.

 

[Guest]

Louise:

All of our doctors call us regardless of results..except one doctor. Everytime something is done to Al or to me, if they don't call I still need varification. I call them. For years, they told me...we only call when there is a problem. Well, that very same doctor is now dealing with a very bad problem with one of his patients. The patient should have been called and was not. Someone messed up and the call was not made...could happen in any busy doctor's office..

For me, the only way I am sure that all is well is that I receive a call from the doctors office saying so. I request to be called with results period, and then I request that they send me a copy of the test results.

Mistakes do happen.

Kind regards,
Blanche

Hi Blanche, your example of a patient who did not get the call is exactly why I don't want to have my primary care physician manage my coumadin and INR. With my own home testing I hope to one day be able to self-dose without having someone hovering over me and managing my coumadin for me. Just like Ross and Karlynn.

 

[Guest]

The cynical side of me wonders if there's something else going on. I heard somewhere that the dr office can't bill the ins. co for a PATIENT phone call- maybe they can if the call is from an outside agency calling ABOUT the patient- gets treated like a consultation. I don't know but anything's possible

You got it Cris. No money being made with me so they may be looking for a way to capture something for their trouble.

 

[Blanche]

Even self-testers sometimes require help

Even self-testers sometimes require help

Louise:

Al and I both self-test...Albert because of a replaced mitral valve and me because of A-fib. We both self-dose.

After 8 years of self-dosing, there still are times when we need and want the assistance of of our primary care physician (internist) to help us with difficult situations.

I consider both of us to be very well versed in the literature of anticoagulation and we have the expertise of Ross and members here to guide us. But, sometimes that is not enough.

When Al's INR went beyond the 9.00 that the INRatio measures, we were certainly glad to have our lovely Dr. B. to guide us. He recommended another finger stick test on his INRatio. He also took a blood draw and requested a stat report. Then, when it was determined that the reading of 9.0 plus seemed correct, he recommended treatment to bring down the INR
quickly. That involved a prescription which he had to write.

Our doctor also monitored Al's progress and requested another comparison test with his INRatio and ours three days later. INR was in therapeutic range then.

People who self-test have two resources: their tester and their knowledge of anticoagulation. They also need, as our experience shows, a medical profession for the times when big time problems happen.

If you choose to self-test and self-dose, you must make yourself expert in the various aspects of anticoagulation. I would also suggest that you have a doctor as back-up should difficulties arise.

I wish you the very best.

Blanche

 

[Guest]

Louise:

People who self-test have two resources: their tester and their knowledge of anticoagulation. They also need, as our experience shows, a medical profession for the times when big time problems happen.

If you choose to self-test and self-dose, you must make yourself expert in the various aspects of anticoagulation. I would also suggest that you have a doctor as back-up should difficulties arise.

I wish you the very best.

Blanche

Thanks Blanche, I agree with your statement that there will be times I need my doctor's assistance. My cardiologist set me up with the coumadin clinic so that I would not be out there on my own. With the coumadin clinic nurses comments yesterday I get the feeling that they are passing me off to a third party, not telling me the 'whole story', and I'm not sure how I feel about that. When I met with my family physician yesterday I had already done my research and knew that crestor interacts with coumadin. I explained to her that I thought I should test in 3 days, see where my INR is, adjust from there. She was in agreement and stated that she would advise that. So I feel comfortable with my family physician, it's just that history has proven that the doctor doesn't always get the messages that patients leave and it's sometimes the staff who take the call who drop the ball for whatever reason.

Believe me, if an issue comes up, I won't hesitate to call anyone. I am considering asking my family physician to take over my coumadin management when I see her in 3 months for bloodwork. When I mentioned this possibility to the coumadin clinic nurse, she jumped at that suggestion but I put it back in her court to do her thing and let me know, then I'll decide what I want to do.

Thanks for sharing.