Barriers and facilitators to optimal oral anticoagulant management: a scoping review

Wang, Mei; Holbrook, Anne; Lee, Munil; Liu, Jiayu; Leenus, Alvin; Chen, Nora; Mbuagbaw, Lawrence; Thabane, Lehana

doi:10.1007/s11239-020-02056-0

Cited by 10 publications

(17 citation statements)

References 92 publications

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“…Codes developed during conventional content analysis were organized into four main themes according to their impact on OAC management: medication-related factors, patient-related factors, provider-related factors and system-related factors [ 8 ]. These are summarized in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…The analyst ensured that there was at least one exemplar from the data for each code and category and recorded all decisions related to the coding and analysis process in a study audit trail [ 22 ]. Categories were collated into themes that we had previously developed in our scoping review [ 8 ]. The research team assessed data saturation through a review of all transcripts, coding reports and by examining the audit trail.…”

Section: Methodsmentioning

confidence: 99%

“…Until the last decade, warfarin was the dominant OAC, with its own detailed requirements for management [ 7 ]. Multiple studies, with very few randomized trials, have addressed barriers and facilitators for high quality warfarin management [ 8 ]. Attitudes towards regular blood testing, concerns regarding adverse drug interactions, and the perceived requirement for very high INR time in therapeutic range, appear amongst the many proposed barriers and facilitators but are specific to warfarin [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies, with very few randomized trials, have addressed barriers and facilitators for high quality warfarin management [ 8 ]. Attitudes towards regular blood testing, concerns regarding adverse drug interactions, and the perceived requirement for very high INR time in therapeutic range, appear amongst the many proposed barriers and facilitators but are specific to warfarin [ 8 ]. As DOAC (direct acting oral anticoagulant–apixaban, dabigatran, edoxaban and rivaroxaban) utilization has markedly increased to become the dominant OAC in many countries, it is unclear if there are still unmet barriers in provider monitoring, patient knowledge, individual benefit:harm assessment, adherence, etc.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Em relação às metas gerais em autocuidado, aquelas propostas demonstraram consonância com o conceito de manutenção, monitoramento e gestão do autocuidado, já definidos pela literatura, os quais podem reduzir os índices de mortalidade e incidência de tromboembolismo em usuários de varfarina, como também estimular melhores hábitos de saúde. [24][25][26] Dentre as metas gerais, a mais relatada após o primeiro CC foram relacionadas à prática de atividade física (22; 66,6%), condizente também com o resultado encontrado por uma intervenção educacional baseada na teoria sociocognitiva. 26 O exercício físico está intimamente ligado à prevenção de diversas comorbidades, principalmente cardiovasculares, as quais podem corroborar no uso concomitante de diversos medicamentos.…”

Section: N = 102unclassified

Proposição e cumprimento de metas de autocuidado por pacientes em anticoagulação oral durante uma intervenção educacional baseada no empoderamento

Ortiz¹,

Costa²,

Nascimento³

et al. 2021

Rev Bras Farm Hosp Serv Saude

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Objetivo: Identificar proposição e cumprimento de metas de autocuidado gerais e específicas relacionadas ao tratamento anticoagulante estabelecidas por pacientes em uso de varfarina durante uma intervenção educacional pautada no empoderamento em saúde em um país de média renda. Métodos: Estudo descritivo realizado com 103 pacientes atendidos em uma clínica de anticoagulação (CA) de Minas Gerais. Critérios de inclusão: idade ≥ 18 anos, ambos os sexos, uso de varfarina > 6 meses, diagnóstico de fibrilação atrial valvar ou não valvar, atendimento na CA entre julho a dezembro de 2018, baixa qualidade na anticoagulação oral e participação no primeiro e/ou segundo círculo de cultura (CC) da intervenção educacional (IE). Critérios de exclusão: impossibilidade de comunicação verbal, surdez, cegueira ou problema de saúde que comprometesse o comparecimento à CA. A proposição de metas ocorreu entre abril e julho de 2019, durante a IE, a qual foi composta por quatro CC mensais com diferentes temáticas. No intervalo entre eles, realizou-se interação mediada por telefone utilizando-se o Protocolo de Mudança de Comportamento. Foram consideradas as variáveis sociodemográficas, metas gerais e específicas propostas e relato de cumprimento das mesmas. Realizou-se a correlação entre o número de pacientes que participaram de cada CC e sexo biológico e análise estatística descritiva. Resultados: Os pacientes apresentaram média de idade de 64,2 (DP 12,7) anos, com predominância do sexo feminine (71; 69,6%;). Dos 33 pacientes que propuseram metas gerais, 60,6% (20) cumpriram e 80,7% (67) dos 83 pacientes que atenderam ao telephone cumpriram as metas específicas. As metas específicas mais cumpridas (37; 74,0%;) foram aquelas relacionadas à alimentação, mencionada em um total de 50 vezes, enquanto a meta geral mais realizada (3; 75,0%) se referiu às demais práticas de autocuidado, mencionada em um total de 4 vezes. A meta específica que teve maior porcentagem de não cumprimento (60,0%; 6) foi a relacionada à atividade física, mencionada em um total de 10 vezes, com valor de p estatisticamente significativo (0,001). Conclusão: Intervenções educativas podem contribuir para a identificação e cumprimento de metas em pacientes utilizando varfarina, sendo recomendada a realização de estudos mais robustos.

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Anticoagulation under-utilization in atrial fibrillation patients is responsible for a large proportion of strokes requiring endovascular therapy

Shakibajahromi

Kasner

Schmitt

et al. 2023

Journal of Stroke and Cerebrovascular Diseases

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Barriers and facilitators to optimal oral anticoagulant management: a scoping review

Cited by 10 publications

References 92 publications

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

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

Proposição e cumprimento de metas de autocuidado por pacientes em anticoagulação oral durante uma intervenção educacional baseada no empoderamento

Anticoagulation under-utilization in atrial fibrillation patients is responsible for a large proportion of strokes requiring endovascular therapy

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