title: Introduction of point of care analysis for prescribing warfarin at a Swedish primary care centre.
abstract: Boo Health Centre in Nacka, Sweden, manages approximately 240 patients on warfarin treatment. A risk analysis showed that testing and prescribing of warfarin involved 28 different steps and nine parties, leading to a high risk of errors. The aim of the study was to shorten and simplify the process flow for the testing and prescription of warfarin by introducing point of care analysis (POC). The aim was also to evaluate changes in time expenditure and cost related to the new processes well as the quality in form of time in therapeutic range (TTR) and number of adverse events. A study with POC was performed during six months in 2014. Time expenditure, cost, TTR, and adverse events related to warfarin treatment were recorded. An evaluation was also conducted in the form of surveys to patients and staff regarding satisfaction with the new process. The process was shortened from 28 steps and nine parties involved to nine steps and four parties involved. The patient got their test result and met with the prescribing doctor, all within the same visit, meaning that the feedback time for patients was shortened from one to three days by mail to less than 10 minutes at the medical centre. TTR did not change and the incidence of adverse events was not affected. The surveys showed that the overwhelming proportion of patients, doctors, assistant nurses, and laboratory staff were pleased with the changes and the patients would recommend others to monitor their treatment at Boo Health Centre. There was a reduction in time expenditure for the staff. The costs decreased from approximately 8 000 €/month to about 7 000 €/month. The introduction of the POC method enabled a shorter process flow with reduced time expenditure for both patients and staff and reduced costs. TTR did not change. Patients and staff were satisfied with the changes and the patients could take a more active role in their treatment. It is possible that POC analysis may have implications on improved compliance to warfarin treatment, if so, it will increase patient safety.
authors.affiliation: Boo Primary care centre, Stockholm health care services and Centre for evidence based medicine, Stockholm county council, Sweden.
authors.forename: Rita
authors.initials: R
authors.lastname: Fernholm
authors.affiliation: Boo Primary care centre, Stockholm health care services and Centre for evidence based medicine, Stockholm county council, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Hermansson