Sent Request to Kaiser Permanente

[Marty]

Ruth, Kaiser's wonderful Health Connect enabling you to get your results quickly is a great advance. Now I would like the pharmacists to do protimes with INRatio at point of care and you would get your results even faster and not have to have a vein stick. However as posted earlier by me ,our pharmacist at Falls Church said with great certainty that the finger stick monitors are "inaccurate". Maybe she should take one of Al Lodwicks CME's-or read some of the evidence based research by Dr.Jack Ansell published in JAMA and other journals.

 

[ScribeWithALancet]

Thanks for the great video link on this topic. I want to join the small percentage of self-monitoring individuals and have just emailed my doctor (with Kaiser Permanente) to find out if I can get this covered through them. If not I will do what I need to do to get it on my own. I have complained to both my cardiologist and my primary care doctor about a need for a self-testing device (similar to that for diabetics) to monitor my levels on my own. All they said was that the anticoagulation group does a good job of managing levels and to take my regular (every 3 week) PT/INR tests. Now thanks to this site I found that this technology already exists!

Here is the email I sent:
I would like to move to self monitoring of my anticoagulants. As you know I recently had a 5 hour nose bleed and had to go to ER where I found out that my PT/INR was 4.0 (it was 3.5 just 4 days prior to that). There are several manufacturers available on the market. I have learned that Medicare covers this for mechanical heart valve patients (I am not on Medicare). There are some very informative videos available at http://discoveryhealthcme.discovery.com/anticoagulation/anticoagulation.html if you'd like to check them out (CME credit is available too). The 4 short videos are available under View the Program Online and do not require registration to access. Does Kaiser Permanente offer this to its patients (who qualify)? Since I will probably be taking this therapy for as long as I have this valve managing this level more diligently is of very high importance to me and my family.

Thank you,
Karen Christian

Of course I will post my experiences as I travel down this path.

VW.COM Rocks!

Karen,
Look in the Durable Medical Equipment (DME) section of your Kaiser Benefits Brochure. Mine includes a section that says INR Testing Equipment as the last paragraph. However, it is Kaiser Mid-Atlantic so it may be different from yours.. I have found that some Kaiser's include this as a benefit and others do not.

The Colorado Kaiser even did a study on INR Self Management. Unfortunately, it was not for user's of INR Home Testing Equipment but for proving that INR Self Management worked (it did). I purchased a Coag-Sense from Willburn Medical. However, Kaiser will not recognize it as being of use in talking with them even though it tracks the Kaiser lab like your shadow tracks you in the bright sun. It was not purchased thru Kaiser.
Do not expect your doctor to know this information. It is well concealed. Neither my doctor nor my Coumadin Pharmacist knew it. I had to dig, dig, dig, it out of membership services. Look in the benefits brochure. You might have to download a pdf and do a search for INR. If that does not work do a search for test.
If you can get an INR test meter through Kaiser - great. If you cannot, get your own on your own as I did. The meter has come in quite handy in these sequestered times. If your plan includes meters and you get it thru them, then they might be forced to acknowledge it rather then to gracefully ignore it as they did with me.
I have had better luck then you with my clinic. However, one of my previous Pharmacists suggested that I eat the same amount of salad greens every day (2 ounces of spinach which approximates 300 of K1). This significantly reduced my variation in K1 as most other vegetables have 50 mcg of K1 at most. A variation of 50 with a base of 300 is a lot smaller then a variation of 50 with a base of 50. He later suggested that I use 100 mcg pills of K1 when I was traveling because I could not find the spinach. We trialed the pills "at home" for a couple weeks and they worked as well as the spinach.
Do remember that Kaiser has had much better luck keeping members in range with their AntiCoagulation Clinic then most. This is possibly because their pharmacists have more experience in AntiCoagulation then most. I had some horrible experences during the two years I left Kaiser to help my wife. She told me the non-Kaiser clinics were far worse and to go back. As ProtimeNow told me, managing INR is an art and +-0.2 is great. My Coag-Sense and my regions INR Blood Labs march within 0.1 of each other, once regression equations are calculated, so both machines must be very well calibrated to the ISI standard and thus match each other.
Oh, look up Stacey Johnson, MD of the University of Utah and INR using Google or Duck Duck Go and read the abstracts. He uses INR test meters because many of his patients are FAR FAR AWAY and cannot come to his Blood Draw Laboratory at the University Hospital except when it is urgent. He wanted to find out how accurate the meters were and found them ok, but with regression statistics, found he could shift that to very good from INR ranges of 2 to 5. Thus, Home metering and management can work well. Microsoft Excel or Apple Numbers can do all the regression statistics for you.
Walk in His Peace, and Six Feet Away, ; - )
Scribe With a Lancet

 

[ScribeWithALancet]

Mid-Atlantic Kaiser says no!

Mid-Atlantic Kaiser says no!

I work as a radiologist at Kaiser Falls Church Virginia. Anticoagulation is handled by a "Coumadin Clinic" managed by two PhD pharmacists. I talked to one of the managers today and she said Kaiser will not pay for self monitors or strips. She said she did not believe the self monitors like INRatio were as accurate as the central lab. I didn't argue but simply thanked her for the information. For those that don't know my history , my cardilogist told me to get a monitor in 1998 at my first post op visit and I've been self testing and and self dosing ever since and my doctors are very happy with it as I am.I trusted Coaguchek for years and now use the INRatio. I get a lab check once a year and we are always close.

Marty,
Dr. LeFrak did my surgery as well in 2004. He was superb. I understand that he is retired now.
I started self testing last year and have been rigourously documenting everything on a spreadsheet per ProtimeNows suggestions. Dr. Stacey Johnson of the University of Utah did a series of papers with the Pharmacists at their AntiCoagulation Clinic to facilitate his patients using INR test meters to avoid diriving across half of Utah for a blood draw. He documented that you could correlate INR test meters to the Lab Blood Draw and what the limits and issues were. The limits of the correlation are the limits of any regression analysis - the conditions have to stay the same. e.g. same home meter and reagents on the strips on the home side and same Lab INR machine and reagents on the lab side. The reagents have to be ISI calibrated reagents. Once these conditions are met he found that the CoagUChek XS and Coag-Sense both correlated well enough wth the lab that he could have his patients only come in when boundary conditions were exceeded. His boundary conditions wer INR too high or too low. Kaiser Mid-Atlantic theoretically has INR test meters available as Durable Medical Equipment in its benefits brochure. They (the Coumadin Clinic Pharmacist and a prior manager) tried to help me get one and it was a long series of trip ups. Easier to do what you did. Maybe I will see you some day at Falls Church - I usually go to Burke or Tysons but my internist says that with my medical conditions I should stay home as if my life depended on it.
Walk in His Peace, and 6 feet away ; - )
Scribe With a Stylus

 

[LondonAndy]

Scribe, if I may be informal: this thread was 12 years old...

 

[Protimenow]

Hey, LondonAndy - it STILL IS - 12 years old - but it was revived by Marty.

Although anticoagulation clinics follow set protocols, I am concerned to hear that 'every three weeks' is adequate testing for any clinic. A study that I frequently quote, says that, if the INR is below 2 for as little as 10 days, a clot can form. I'm a lot more comfortable with weekly testing.

Both Roche (manufactures of CoaguChek XS, Vantus, and their other meter) and Coagusense (manufacturers of Coag-Sense PT1 and PT2) take great care to be certain that their strips accurately match the reagent values. They're betting their share of the market that they do - and, if found to be wrong, can potentially be forced to withdraw from the market entirely. With all that said, I've experienced a significant (up to a full point) difference between my Coag-Sense (and strips from a few different lots) to be lower than eith the CoaguChek XS or the labs - with no good explanation.

In my experience, I've purchased CoaguChek XS, CoaguChek S (now discontinued), InRatio (now discontinued), Protime (I thnk it's been discontinued), and my first Coag-Sense meter on Ebay. I've purchased most of my strips on eBay, although I was able to get some strips from Alere (which made the InRatio), and some for testing from Coagusense.

If the meters one eBay aren't sent with return privileges, I would avoid them. However, most meters are probably fine - the new meters are made with a number of fail-safe features. They're designed to do thousands of tests, over many years, at clinics and doctor's offices. Although home testing may be a good piece of the market, these meters are designed to work for many more tests than a user will probably ever take.

As far as being a self-tester (and self-managing my dosage), when I was in the hospitial, none of the doctors believed that a) I self-tested or b) I was able to self-manage. Apparently, we're a small minority of patients on warfarin, out of a much larger population of warfarin users.

Perhaps we should get monogrammed hats that can be worn in doctor's offices - this would say IST ISM (for I self-test, I self-manage).

So - keep pounding on Kaiser for a meter. You don't necessarily have to go to a medical distributor for your device (you can probably buy a good one on eBay for less money), and probably only buy around 50 strips at a time -- this way, you'll be pretty confident that you won't have expired strips that you haven't used before your supply runs out.

You can even try to convince Kaiser that you think that you may be at risk of COVID-19, and that you'd rather test at home than take the risk for you, and the clinic tech, by testing at home. Who knows? This reasoning may work on them.

OK - the thread has sprung back into life....

 

[ScribeWithALancet]

Scribe, if I may be informal: this thread was 12 years old...

Thank you. No offense taken. The thread popped up on my screen and I saw "Kaiser" not the date. Then, I saw my cardiac surgeon's name. Wow. His seeing me on short notice, agreeing with my wife that I had congestive heart failure and then adding that "you are going into surgery next week" is the reason that I am still here.
Walk in His Peace,
Scribe With a Stylus

 

[Amy]

if the INR is below 2 for as little as 10 days, a clot can form.

Hello.
I know this thread is a bit old, but could you share that study? Thank you.