Innovative Approach to Improve Healthcare Outcomes of a Bleeding Disorder
e-Health ePoster Library. Othman M. Jun 5, 2017; 167111; EP04.02
Prof. Dr. Maha Othman
Prof. Dr. Maha Othman
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Abstract
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Purpose/Objectives: Rare inherited bleeding disorders such as platelet type von Willebrand disease (PT-VWD) exhibit considerable diagnostic challenges; however, standard guidelines for their management are as yet unavailable. Lengthy periods of misdiagnoses and subsequently inappropriate treatments resulting in significant morbidity can have serious implications on both patients and health care systems. Mysteries around the disease exist and research funding is scarce, leaving scientists with limited resources to support underprivileged patients. The purpose of this study is to propose a new interdisciplinary approach involving the primary care physician, the hematologist, and the laboratory, to improve diagnosis and management of PT-VWD.

Methodology/Approach: Extensive international work www.pt-vwd.org on this rare disease with over 10 years of experience (Othman etal., J Thromb Haemost. 2016;14(2):411-4) and established International Society of Thrombosis and Haemostasis guidelines for diagnosis of inherited platelet disorders (Gresele etal., J Thromb Haemost 2015; 13: 314–22) together with a recent case series report (Sánchez-Luceros etal., Platelets 2016; in press) have provided the foundation for this proposal. The required resources including physician awareness/education, appropriate laboratory tests and personnel training were examined. Models from other systems/countries have also been evaluated. The proposal is based on: integration of a specific education module into physicians’ (primary care and hematologists) CME program, improved recognition and referrals of abnormal bleeding conditions (thrombocytopenia and VWD) in the primary care setting and the implementation of a simple diagnostic algorithm, where essentially all patients with provisional diagnosis of type 2B VWD and undiagnosed adult or neonatal thrombocytopenia, would undergo a simplified RIPA mixing assay (Favaloro Semin Thromb Hemost 2008; 34: 113–27) followed by genetic analysis for confirmation.

Finding/Results: A flow chart representing the diagnostic problem, implications of delayed diagnoses and the suggested interdisciplinary approach involving all stakeholders together with the proposed diagnostic algorithm will be presented.

Conclusion/Implications/Recommendations: It is anticipated that incorporating this approach directly into the clinical setting will enable timely and improved diagnosis of the disease, reduce health care costs resulting from unnecessary and misdirected lab testing, inappropriate treatments and most importantly minimize patients’ serious bleeding complications.

140 Character Summary: New interdisciplinary approach to improve diagnosis of PT-VWD and reduce healthcare costs resulting from misdirected lab testing and inappropriate treatments.
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