Home' Australian Ageing Agenda : AAA Spt-Oct 2013 Contents References:
1. DiMatteo MR. Formulary 1995; 30: 596--8, 601--2, 605.
2. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, Perera R, Meats E, Glasziou P. Self-monitoring of oral
anticoagulation: a systematic review and meta-analysis. Lancet 2006;367:404-411.
3. Ansell J et al. Int J Cardiol 2005; 99: 37--45.
4. Butchart EG et al. J Thorac Cardiovasc Surg 2002; 123: 715-23.
Roche Diagnostics Australia Pty Limited., 31 Victoria Ave Castle Hill NSW 2154,
Phone: 02 9860 2222 ABN 29 003 001 205
COAGUCHEK, BECAUSE IT'S MY LIFE are trademarks of Roche.
The importance of compliance
• Compliance rate with long-term medication in general has been estimated at between 50% and 60%1
• Evidence shows that INR monitoring improves the quality of oral anticoagulation between 50% and 85%2
The obvious choice is partnering VKA and
CoaguChek® XS Plus for improved compliance
* Aged Care Standards and Accreditation Agency Ltd, Accreditation Standard 2, 2.7 Medication management.
Compliance and monitoring - inter-related
factors in oral anticoagulation
...two essential components for optimising
oral anticoagulation therapy enables quality of care.*
Warfarin -- a particular case in point
• This is increasingly prescribed as lifelong therapy for patients with mechanical heart valves, atrial
fbrillation or thrombophilic disorders, effectively preventing arterial embolism in a wide range of
• Maintaining INR within its therapeutic range is effectively achieved through monitoring
• Patients on warfarin who have had a heart valve replacement there was a 32% difference in survival at
15 years between patients with low and high variability in anticoagulation control4
CoaguChek® XS Plus
"And then we are measuring what we do in this other model
and what that costs.
"It's a whole of proposition approach. Here is one model of
care and here is another. Let's measure them pre and post and
see which gets the most value for the consumer," Dudley says.
Both Bupa and the researchers from the University of Tasmania
are confident the trial will deliver strong measurable benefits in
term of care outcomes for residents.
While he is conscious not to sound over-confident at this early
stage, Dudley struggles to hide his delight with early positive signs.
"The engagement is so much better than it used to be and
there really have been some amazing results already.
"In one of the care homes where the GP has been there for
three months, there have been four residents go from being
immobile to walking again.
"These were residents who were previously over sedated. But the
GP has been able to get input from care staff and family members
and properly review their medications and now they are walking."
Dudley says the GPs being recruited have a genuine passion
for geriatric care but also need to be able to work flexibly as
part of the care team, including leading skills development and
training for other staff.
He says it's ultimately about shortening the gap between acute
care and aged care in a way that works for everyone and is still viable.
"The costs are not just our costs but the cost to the system
and to the quality of care for the individual. What difference does
it make having the doctor in a prevention and management role
versus having doctors come in at the end, after the illness.
"We're looking for a statistically significant business case.
We will no doubt tweak some things that do seem costly for the
benefit, but you have to learn as you go.
"The aged care funding model we have isn't greatly informed
about these kinds of care models and no amount of fixing up
what we have can compare with seeing if there is another, better
way," said Dudley.
ADDRESSING THE SKILLS ISSUE
Professor Andrew Robinson is also confident that this model
of care can help address the issue of a declining skills base in
residential aged care facilities, just at a time when resident care
needs are escalating.
He believes big gains can flow from raising the skill levels of
care home staff, which is part of the purview for the GPs in the
program. It will also enable medical students and GP registrars
to gain valuable exposure to aged care which will in turn help to
attract more health professionals into the aged care setting.
"There is a statistical correlation between giving people the
exposure to aged care and then them choosing to work there,"
"This isn't about 'medicalising' the 'social model' of aged care,"
he says. "That's not the point. The point is we have people who
are not getting their care needs met. The social model of care just
needs some more medical input but that doesn't mean you throw
the baby out with the bathwater."
Robinson is convinced that the trial will see significant
improvements across many measures.
"If we can reduce drug use or halve transfers to hospital; if we
can measure improved skill levels and reduced absenteeism and
staff turnover, there will be enormous savings," Prof Robinson said.
"You might say it is 'visionary'," he says. "But it's just smart. If
you want to innovate, Bupa will have five years on everyone else."
Dudley however, is reluctant to go in for much chest-beating.
"Don't say it's pioneering and revolutionary," he says. "Really,
we're just trying to get some evidence. We are wanting to show
that maybe we can do things a different way that will probably
be better for everyone. For nurses, residents, government and
for our business." n
AAA published a news story about the launch of Bupa's
GPs in aged care initiative. For further details, go to
www.australianageingagenda.com.au and search
'Romancing GPs in aged care'.
www.australianageingagenda.com.au | 37
Links Archive AAA Jul-Aug 2013 AAA Nov-Dec 2013 Navigation Previous Page Next Page