scholarly journals Factors influencing primary care physicians’ prescribing behavior of anticoagulant therapy for the management of patients with non-valvular atrial fibrillation in Singapore: a qualitative research study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shera Chaterji ◽  
Lay Geok Lian ◽  
Ting Yee Lee ◽  
Liwei Chua ◽  
Sabrina Yi-Mei Wee ◽  
...  

Abstract Background Oral anticoagulant therapy use in patients with atrial fibrillation (AF) remains suboptimal in Singapore, despite the availability of both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs). Primary care physicians’ (PCP) decision-making to initiate and select appropriate anticoagulant medication is pivotal in reducing complications among patients with AF. This study explored the factors influencing PCPs’ decision-making in anticoagulant initiation and anticoagulant switch for patients with non-valvular AF. Method The study design is qualitative research based on the theoretical framework of the Generalist Wheel of Knowledge, Understanding and Inquiry. In-depth interviews or focus group discussions were conducted with 27 PCPs in general practice in urban Singapore. The audio-recordings were transcribed and coded to identify themes, which are framed according to the “clinician”, “patient”, “medical condition and treatment” and “healthcare system and policy” domains. Results Personal training and experience with anticoagulant therapy; understanding patient risk-stratification; AF detection during clinical practice; medication cost; clinical support services for anticoagulation monitoring and constraints in existing care model influenced PCPs in their anticoagulant prescription. PCPs preferred to seek guidance from cardiologists in managing patients with newly diagnosed AF and attempted to engage their patients in decision-making regarding anticoagulant therapy. Some PCPs perceived sub-specialized primary care clinics focusing on AF co-management with cardiologists as an ideal setting for initiation and maintenance of anticoagulant therapy. Conclusions PCPs are influenced by multiple interrelated factors while making decisions on anticoagulant initiation and anticoagulant switch for patients with AF. Their proposed care model to address the barriers awaits feasibility and acceptance assessment in future research.

2021 ◽  
Author(s):  
Shera Chaterji ◽  
Lay Geok Lian ◽  
Ting Yee Lee ◽  
Liwei Chua ◽  
Sabrina Wee ◽  
...  

Abstract Background: Oral anticoagulant therapy use in patients with atrial fibrillation (AF) remains suboptimal despite the availability of both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs). Primary care physicians’ (PCP) decision-making to initiate and select appropriate anticoagulant medication is pivotal in reducing complications among patients with AF.Aim: This study explored the factors influencing PCPs’ decision-making in anticoagulant initiation and adjustment for patients with non-valvular AF. Design of study: Qualitative research based on the theoretical framework of the Generalist Wheel of Knowledge, Understanding and Inquiry. Method: In-depth interviews or focus group discussions were conducted with 27 PCPs in general practice in urban Singapore. The audio-recordings were transcribed, audited and coded to identify themes, which are framed according to the “clinician”, “patient”, “medical condition and treatment” and “healthcare system and policy” domains.Results: Personal training and experience with anticoagulant therapy; understanding patient risk-stratification; AF detection during clinical practice; medication cost; clinical support services for anticoagulation monitoring and constraints in existing care model influenced PCPs in their anticoagulant prescription. PCPs preferred to seek guidance from cardiologists in managing patients with newly diagnosed AF and attempted to engage their patients in decision-making regarding anticoagulant therapy. They perceived sub-specialized primary care clinics focusing on AF co-management with cardiologists as an ideal setting for initiation and maintenance of anticoagulant therapy.Conclusion: PCPs’ decisions on anticoagulant therapy is influenced by personal attributes, patients, clinical presentations, anticoagulant properties and healthcare system. Their proposed care model to address the barriers awaits feasibility and acceptance assessment in future research.


2020 ◽  
Author(s):  
Shasha Ye ◽  
Tianhao Wang ◽  
Arthur Liu ◽  
Ying Yu ◽  
Zhigang Pan ◽  
...  

Abstract Background:As a large number of Community Health Service (CHS) centers in China face the majority of patients with non-valvular atrial fibrillation (NVAF), primary care physicians (PCPs) play a primary role in the prevention of embolization. Therefore, an awareness of anticoagulant management in patients with NVAF must be brought into focus among PCPs in China. This study investigated PCPs’ knowledge, attitudes, and practices toward anticoagulant therapy in patients with NVAF, to help them understand their shortcomings regarding oral anticoagulant (OAC) therapy in preventing embolization.Method:This was a cross-sectional observational study of 462 PCPs in CHS centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program.Result:Among 462 participants, 69.3% (320/462) of females received a medical bachelor’s degree and over 50% of participants had more than 10 years of work experience. Each section for knowledge, attitude, and practice were categorized as poor (≤39.0%), fair (40.0%–69.0%), and good (≥70.0%). The level of knowledge of OAC therapy for patients with NVAF among PCPs was insufficient in over half (75.8%) of the participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of patients with NVAF.Conclusions: The knowledge and behaviors of PCPs were insufficient for OAC therapy to prevent embolization in patients with NVAF. The study also revealed that there is good potential for PCPs’ educational interventions to positively impact the care of patients with NVAF.


BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023832 ◽  
Author(s):  
David Silvério Rodrigues ◽  
Paulo Faria Sousa ◽  
Nuno Basílio ◽  
Ana Antunes ◽  
Maria da Luz Antunes ◽  
...  

IntroductionGood patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.Methods and analysisThis will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.Ethics and disseminationThis review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).PROSPERO registration numberID 91978.


2020 ◽  
Author(s):  
Shasha Ye ◽  
Tianhao Wang ◽  
Arthur Liu ◽  
Ying Yu ◽  
Zhigang Pan ◽  
...  

Abstract Background: As the large number of Community Health Service (CHS) centers in China face the majority of non-valvular atrial fibrillation (NVAF) patients, primary care physicians (PCPs) play the primary role in the prevention of embolization. Therefore,an awareness of anticoagulant management in NVAF patients must be brought into focus among PCPs in China. This study will investigate PCPs’ Knowledge, Attitude and Practice toward anticoagulant therapy in patients with NVAF and help PCPs increase their awareness of oral anticoagulant (OAC) therapy for NVAF to prevent embolization.Method: This was a cross-sectional observational study of 462 PCPs in CHS centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program. Result: Among 462 participants, 69.3% (320/462) of females got a medical bachelor’s degree and over 50% participants had more than 10 years of work experience. According to similar study, each section for knowledge, attitude, and practice were categorized as poor (≤39.0%), fair (40.0%–69.0%), and good (≥70.0%)[18]. The level of knowledge of OAC therapy in patients with NVAF among PCPs was insufficient in over half (75.8%) of participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of patients with NVAF. Conclusion: The knowledge and behaviors of PCPs were insufficient in OAC therapy to prevent embolization in patients with NVAF. The study also revealed there is good potential for PCPs’ educational interventions to positively impact on the care of patients with NVAF.


2018 ◽  
Author(s):  
Molly Beinfeld ◽  
Suzanne Brodney ◽  
Michael Barry ◽  
Erika Poole ◽  
Adam Kunin

BACKGROUND A rural community-based Cardiology practice implemented shared decision making supported by an evidence-based decision aid booklet to improve the quality of anticoagulant therapy decisions in patients with atrial fibrillation. OBJECTIVE To develop a practical workflow for implementation of an anticoagulant therapy decision aid and to assess the impact on patients’ knowledge and process for anticoagulant medication decision making. METHODS The organization surveyed all patients with atrial fibrillation being seen at Copley Hospital to establish a baseline level of knowledge, certainty about the decision and process for decision making. The intervention surveys included the same knowledge, certainty, process and demographic questions as the baseline surveys, but also included questions asking for feedback on the decision aid booklet. Stroke risk scores (CHA2DS2-VASc score) were calculated by Copley staff for both groups using EMR data. RESULTS We received 46 completed surveys in the baseline group (64% response rate) and 50 surveys in the intervention group (72% response rate). The intervention group had higher knowledge score than the baseline group (3.6 out of 4 correct answers vs 3.1, p=0.036) and Decision Process Score (2.89 out of 4 vs 2.09, p=0.0023) but similar scores on the SURE scale (3.12 out of 4 vs 3.17, p=0.79). Knowledge and Process score differences were sustained even after adjusting for co-variates in stepwise linear regression analyses. Patients with high school or lower education appeared to benefit the most from shared decision making, as demonstrated by their knowledge scores. CONCLUSIONS It is feasible and practical to implement shared decision making supported by decision aids in a community-based Cardiology practice. Shared decision making can improve knowledge and process for decision making for patients with atrial fibrillation. CLINICALTRIAL None


Author(s):  
Stephanie Carlin ◽  
Alison Bond ◽  
Peter Gross ◽  
Alan Bell ◽  
James Douketis ◽  
...  

2017 ◽  
Vol 27 (2) ◽  
pp. 158-166 ◽  
Author(s):  
Diana N. Carvajal ◽  
Deborah Gioia ◽  
Estefania Rivera Mudafort ◽  
Pamela Bohrer Brown ◽  
Beth Barnet

2012 ◽  
Vol 32 (11) ◽  
pp. 771-777 ◽  
Author(s):  
Gaetano Piccinocchi ◽  
Matteo Laringe ◽  
Bruno Guillaro ◽  
Giovanni Arpino ◽  
Roberto Piccinocchi ◽  
...  

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