It will become as common as home glucose testing

[Guest]

Research suggests patients who require warfarin treatment after heart valve replacement should be taught to use coagulometer before leaving hospital.
MedWire (6/10, Williams) reported that individuals "who require warfarin treatment after heart valve replacement should be taught to use a coagulometer before leaving hospital," according to a study published in the Annals of Thoracic Surgery. The researchers from the Mayo Clinic "recruited 50 adults, aged a median of 54 years, who were undergoing mechanical valve replacement." While "[p]atients usually do not begin" international normalized ratio (INR) "self-testing until several weeks or months after hospital discharge," the researchers "hypothesized that beginning instruction in the days following surgery could allow patients to learn to use their coagulometer while having continuous access to medical staff." Patients enrolled in the study "began self-testing instruction an average of four days after surgery. They required an average of 3.5 sessions, lasting 20 minutes, before they were discharged from hospital." Approximately 30 days "after leaving [the] hospital, all but one of the patients were able to self-test, despite none of the patients receiving any further training."

 

[Guest]

Slightly before the "hot place" freezes over.

 

[Bina]

Al, it makes perfect sense to me also. Train the patients in the hospital.
The same day that a person is diagnosed with diabetes they are taught how to use their monitor.
Why should ACT be any different.....
I'm sure that if I would have had my own monitor right away I would have been much more relaxed about ACT.

 

[ALCapshaw2]

That's a start in the right direction.

I wonder how long it will take to filter down
to the average Cardiologist and PCP?

And how long it will take for the Doc's to embrace
Patient Self Testing and 'YIKES' Self Dosing?

THEN we will need for the Insurance Industry to strike a deal with the Instrument Providers.

Don't hold your breath !

I figure I'll have to be on Medicare before I can qualify to get coverage for an INR instrument and Test Strips...

'AL Capshaw'

 

[Ross]

I'd like to see it happen before I expire, but I don't see it as such.

 

[Guest]

Warfarin will probably be replaced before it happens.

After Medicare approves it, then they spend another year or more setting up the rules and regulations.

I watched an interview on C-Span the other night with the guy who is responsible for the assistance dog program for the VA. (Not dogs for the blind but other uses.) A member of Congress pushed through a bill allowing payment for the dogs. But nobody knew what the dogs were really supposed to do or what standards they had to meet. It seemed that everyone with an unwanted puppy wanted to sell it to the VA for an enormous sum. It took several years to determine what different breeds of dogs could do and what level of training they required. The Congress member was mad and dog breeders unhappy that every person who wanted a dog didn't get one the next day.

Pharmacists were give the OK to bill Medicare for warfarin management about two years ago. However, there was no provision that by doing so they would actually get paid. It is still a struggle.

There is still no drug for heart valves in late-stage testing (in the US at least). But there are so many things coming along that somebody will be forced into that niche to make a profit.

Dabigatran (Pradax / Pradaxa) has been approved for prevention of clots after hip and knee surgery in Europe and to treat blood clots in Canada. So things are moving.

 

[Marty]

I called my Kaiser anticoagulation clinic the other day to inquire about a patient. I then asked how we were doing getting our patients to self test with INRatio and Coaguchek. the pharmacist informed me that these devices were "inaccurate" and only the central lab gave readings they could trust. I said "Do you really believe that?" and she said "Oh, yes." I was busy and didn't have time to argue. Are the pharmacists afraid they will lose their jobs if more people are taught to self test and then self dose? My wife is on warfarin now for a-fib and her private practise cardiology group encourages self testing and self dosing. They simply ask her to call in every two weeks with her latest INR and dose schedule, primarily for medico-legal reasons.

 

[Karlynn]

Marty, it's my guess that most of it has to do with the fact that they don't bother to read or educate themselves using the newest papers and studies. As far as they're concerned, what they learned years ago is still the best information. Are they aware of how many labs and doctors' offices use the same monitors that people use in homes?

The reason I started searching out home testing was because our hospital lab started doing the finger stick method and I thought "Now I wonder if I could get one of those for home?" That was probably 6 years ago or more. The only time the lab redid the test with a blood draw was if the INR came back below 2 or over 5.

 

[Marty]

Nice going ,Karlynn. Smart move. Years ago at a medical meeting I asked a DuPont rep what % of patients are smart enough to self test and self dose.
He estimated about 15%.It may be a higher number now that the computer babies are aging.

 

[ALCapshaw2]

Nice going ,Karlynn. Smart move. Years ago at a medical meeting I asked a DuPont rep what % of patients are smart enough to self test and self dose.
He estimated about 15%.It may be a higher number now that the computer babies are aging.

It is my understanding the Home Testing is VERY COMMON in Germany, maybe even the majority of patients use it. I'm not sure. I'll leave the obvious
implication(s) to your imagination.

 

[Bina]

I could understand that maybe the very "senior" or handicapped patients would not be able to consistently use a home monitor, but everyone else of even moderate intelligence can use this machine and self dose. The dosing can be left to a doctor, but mine realized within a few weeks that I knew what I was doing (with the help of VR.com of course), and he knows I will call if I need him.

And yes, Germany is light years ahead of North America regarding medical instrumentation.

 

[melanie]

What is the price of a INR monitor??

 

[catwoman]

My guess is that as time goes on, more people will have the smarts enough to home test, since physicians are so harried nowadays that people are realizing that they, the consumers of medical services, must take the lead with their health and to control runaway health-care costs.

Melanie: Generally about $2,500 in the U.S. if you go through insurance and have the vendor do the filing for you.
Some vendors will discount it by $1,000 if you pay out of pocket.

I love my home-tester. Took it w/ me this weekend when we went to Dallas. Tested yesterday morning in our room at the LaQuinta. Very easy.

 

[Karlynn]

What is the price of a INR monitor??

The retail price is ~$2500. Many insurance companies will cover the majority of the cost. QAS (where most of us got our monitors) will deal with people that are not covered by insurance.

 

[Guest]

It is probably not the pharmacists who fear for their jobs but the lab people. If the pathologist says that they aren't accurate, how many employees have the time or desire to research the facts.

 

[Ross]

I was talking to someone who was around when the glucose meters first came out and he said they were over $1000. He was saying that INR meters are mimicking everything that the glucose meter did before it was accepted by the medical community and then prices dropped as things got moving. We may have a little twinkle in our eyes yet!

 

[lance]

I have the time ............................

I have the time ............................

I called my Kaiser anticoagulation clinic the other day to inquire about a patient. I then asked how we were doing getting our patients to self test with INRatio and Coaguchek. the pharmacist informed me that these devices were "inaccurate" and only the central lab gave readings they could trust. I said "Do you really believe that?" and she said "Oh, yes." I was busy and didn't have time to argue. Are the pharmacists afraid they will lose their jobs if more people are taught to self test and then self dose? My wife is on warfarin now for a-fib and her private practise cardiology group encourages self testing and self dosing. They simply ask her to call in every two weeks with her latest INR and dose schedule, primarily for medico-legal reasons.

Hi Marty,

and will use it well. Last week a pharmacist giving a lecture at my husband's cardiac rehab clinic has the same outlook regarding home monitoring as the one you encountered adding they are not legal in Canada. I will do my best to inform personnel at the clinic and the cardiac hospital associated with it.

 

[SHerrin Hutt]

Protime

Protime

I have had my protime machine since 2002. My first one died after yrs.of use. Qas sent me a new one right away. Humana payed for the first one and medicare payed for the second. They have payed for the testing stuff since my husband retired 3 yrs. ago. Qas took care of everthing. The medicare program that I am now on pays for the supples. I have to test once a week and I call Qas and they send the resuls to my primary care Dr.I have been ajusting my warfine for 5 yrs. I call my Dr. if there is a problem. So far so good. My primary Dr. has the same machine I have. Once in awhile I take my machine in and run it with theirs. It is usally .1 off so far. I have supples for my protime and meter for my glucose. I have machine to download my pasemaker an preloaded needle for my allergy reaction. I had to take the machine to my primary care Dr. and had to show him that I knew how to use it. It was a little scary at first but wasn't long till I was pro at it.