Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers

Abstract

Background Oral anticoagulants (OACs) are very commonly prescribed for prevention of serious vascular events, but are also associated with serious medication-related bleeding. Mitigation of harm is believed to require high-quality OAC management. This study aimed to identify barriers and facilitators for optimal OAC management from the perspective of patients, caregivers and healthcare providers. Methods Using a qualitative descriptive study design, we conducted five focus groups, three with patients and caregivers and two with health care providers, in two health regions in Southwestern Ontario. An expert facilitator led the discussions using a semi-structured interview guide. Each session was digitally recorded, transcribed verbatim and anonymized. Transcripts were analyzed in duplicate using conventional content analysis. Results Forty-two (19 patients, 7 caregivers, and 16 providers including physicians, nurses and pharmacists) participated. More than half of the patients received OAC for the treatment of venous thromboembolism (57.9%) and the majority (94.7%) were on chronic therapy (defined as >3 years). Data analysis organized codes describing barriers and facilitators into 4 main themes—medication-related, patient-related, provider-related, and system-related. Barriers highlighted were problems with medication access due to cost, patient difficulties with adherence, knowledge and adjusting their lifestyles to OAC therapy, provider expertise, time for adequate communication amongst providers and their patients, and health care system inadequacies in supporting communications and monitoring. Facilitators identified generally addressed these barriers. Conclusions Many barriers to optimal OAC management exist even in the era of DOACs, many of which are amenable to facilitators of improved care coordination, patient education, and adherence monitoring.

Barriers to self‐monitoring implementation in the oral anticoagulated population: A qualitative study

“…Organizational and individual barriers were detected and preliminarily explored. Although the barriers identified in our study are aligned with the most common barriers described in the literature for the optimal management of OAC (Holbrook et al, 2021;Wang et al, 2020), to the best of our knowledge, these findings represent a novelty considering that the described barriers portray some Italianspecific elements and viewpoints, which were previously unexplored.…”

Use of direct oral anticoagulants in primary care: a qualitative study integrating patient and practitioner perspectives

“…Prior to starting a DOAC, only three patients were previously on warfarin, eight on antiplatelets, four on neither, and one previously on aspirin and warfarin. Therefore, the implications for patient outcomes may be linked to poor understanding of the risks associated with anticoagulants such as bleeding and the stroke risk associated with poor adherence (13,14). This research was conducted in 2018 and there is a risk that the covid-19 pandemic presented even fewer opportunities for medication reviews, routine monitoring, and reinforced messages post index consultations.…”

Perceptions of patients and healthcare providers on patient education to improve oral anticoagulant management

“…The present study was a data secondary analysis of a focus group study. 20 We followed the principles of qualitative description 21,22 and the consolidated criteria for reporting qualitative research (COREQ) guidelines. 23 The protocol for this qualitative research was approved by Hamilton Integrated Research Ethics Board (HiREB #1639) and the Tri-Hospital Research Ethics Board for Kitchener-Waterloo-Cambridge (THREB#2017-0635).…”

“…The present study was a data secondary analysis of a focus group study 20 . We followed the principles of qualitative description 21,22 and the consolidated criteria for reporting qualitative research (COREQ) guidelines 23 .…”