Apulian regional network for the integration of thrombosis centers and social health districts

ABSTRACT

Background: the use of portable coagulometers and the development of telemedicine have enabled the integration between the territory and Thrombosis Centers, leading to the emergence of Decentralized Specialist Assistance. The clinical advantages of DSA are reduction of complications, reduction of the workload of the professionals involved, improvement of patients' quality of life and reduction of OAT management costs. In addition, the DSA allows specialists to create a network linking Thrombosis Centers, blood drawing area, and patients. During the SARS-COV-2 pandemic in the ASL BARI and in the A.O.U Policlinico of Bari in collaboration with the E-Health Area of AReSS Puglia and, Werfen, this model was tested.Methods: 200 patients aged 42 to 96 years managed by the Parma-GTS (Global therapy solution) software Instrumentation Laboratory , were enrolled. For each patient, PT was performed using analytical systems in use in the laboratory (ACL TOP 500 CTS with HemosIL RecombiPlastinTin 2GIL and SYSMEX CS 51000 SYSTEM-SIEMENS with Innovin, Dade) and by digitopuncture with microINR coagulometer ( Instrumentation Laboratory). Patients received an electronic report on various devices (PC, tablet, smartphone) ,after expressing informed consent, through homeTAO an optional service integrated in PARMA GTS. Statistical analysis was performed by linear regression and the Bland Altman method. All patients were given an evaluation questionnaire about the reception, the improvement in the quality of life and the simplicity of capillary sampling compared to venous blood sampling as well as the use of homeTAO.Results: The data analysis showed the concordance of the results of the microINR systems with the systems in use in the laboratory in accordance with ISO 17593 2007. The Pearson's coefficient calculated for all centers is 0.941. In addition, 96% of patients expressed satisfaction with the services offered.Conclusions: the trial demonstrated the possibility of integrating District and thrombosis centres using a single OAT software. The connection of the microINR to the management software allows immediate availability of the analytical data and the homeTAO service allows the domiciliation of the report.