Atrial fibrillation is the commonest heart rhythm abnormality, substantially raising risk of stroke and death and affecting around 8.8 million people in the EU, with up to 2% of the UK population taking oral anticoagulation medication.
Birmingham research has supported a move from lab blood tests and secondary care to primary care and more recently patient self-management through development of new testing and management approaches, which have helped improve clinical outcomes.
Clinical trials led in Birmingham have also proven the safety of anticoagulation therapy in elderly patients, and led to the establishment of the National Centre for Anticoagulation Training within the University, which provides accredited training for health care professionals involved in the management of patients.
Duration: 2.17mins
Speakers
S1 Professor David Fitzmaurice, Clinical Lead, Primary Care Clinical Sciences, College of Medical and Dental Sciences
Transcript
The research we have undertaken at the University of Birmingham, particularly with regards to service delivery, started with looking at how we could safely transfer the management of patients receiving oral anticoagulation from secondary care outpatient clinics into primary care. This was driven essentially by the huge increase in numbers of patients receiving oral anticoagulation.
We initially started with a very small pilot study which looked at treating patients in the community using near-patient testing to do the blood test that is required, known as the INR, for patients receiving oral anticoagulation. We then moved onto a larger study based in twelve general practices around the West Midlands using near-patient testing for the INR test but also incorporating expert computerised decision support software to provide instant dosing for the patients once the blood tests had been undertaken. This study demonstrated improved therapeutic control in terms of INR control and some suggestion that there was a reduction in adverse events, particularly stroke. The impact of this has been to effectively transfer are from secondary care into primary care, both safely and effectively, and the model of care that we developed is now widely known as the Birmingham Model of Oral Anticoagulation.
The further impact of the research undertaken at the University of Birmingham in terms of transfer of care from secondary care to primary care for patients receiving oral anticoagulation was its introduction into the National General Practice Contract as a national enhanced service, which remains current to this day and there has been a shift of perhaps 30-40% of patients out of the traditional secondary care model into patients being managed with the Birmingham Model of Primary Care Management. This has also been adopted internationally and is now recognised as a safe and effective method of service delivery for patients receiving oral anticoagulation.
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