Atrial Fibrillation Patient’s Treatment Experience: A Qualitative Analysis of Rivaroxaban and Warfarin

2021 ◽  
Author(s):  
Dan Sly ◽  
Margaret Husted ◽  
Lynn McKeague ◽  
Tamara Everington
Keyword(s):  
Atrial Fibrillation ◽  
Lived Experiences ◽  
Qualitative Interviews ◽  
Self Management ◽  
Patient Understanding ◽  
Advantages And Disadvantages ◽  
Qualitative Evidence ◽  
Anticoagulant Medication ◽  
Purposive Sample ◽  
Medication Changes

Objectives: In the treatment of atrial fibrillation (AF), anticoagulant medications such as warfarin and rivaroxaban are commonly prescribed to help reduce the risk of ischaemic strokes, and other thromboembolic events. Previous research has highlighted various advantages and disadvantages of each of these medications, but there remains an absence of qualitative evidence regarding the lived experiences of AF patients. The present study aims to address this gap and obtain a greater understanding of the patient experience and beliefs surrounding their selected anticoagulant medication. Design: Semi-structured qualitative interviews with a purposive sample of 20 participants (10 warfarin, 10 rivaroxaban). Interviews were transcribed verbatim and thematically analyzed. Results: Data analysis led to the generation of three key themes: positive perceptions of medication, distrust of alternatives, and inconsistencies in support experiences.Conclusions: Positive perceptions of one anticoagulant medication (ACM) and distrust of alternatives may influence patients’ confidence in switching medications. This is potentially problematic where there is a lack of patient engagement in medication changes. Gaps in patient understanding of anticoagulation, including lack of clarity around medications selection, and misconceptions about treatment, were evident. By addressing these misconceptions, clinicians may be better positioned to support people with AF in self-management of their ACM.

scholarly journals Understanding the Attitudes of Clinicians and Patients Toward a Self-Management eHealth Tool for Atrial Fibrillation: Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Boon Piang Cher ◽  
Gayatri Kembhavi ◽  
Kai Yee Toh ◽  
Jananie Audimulam ◽  
Wei-Yan Aloysius Chia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patient Education ◽  
Technology Acceptance ◽  
Health Care Providers ◽  
Medical Condition ◽  
Qualitative Interviews ◽  
Self Care ◽  
The Self ◽  
Self Management ◽  
Care Providers

BACKGROUND Atrial fibrillation (AF) is the most common heart rhythm disorder and poses a growing disease burden worldwide because of an aging population. A multidisciplinary approach with an emphasis on patient education and self-management has been demonstrated to improve outcomes for AF through the engagement of patients in their own care. Although electronic tools (e-tools) such as <i>apps</i> have been proposed to provide patient education and facilitate self-management, there have been few studies to guide the development of these tools for patients with AF. OBJECTIVE This study aims to explore the perceptions of patients and health care providers (HCPs) and their attitudes toward the use of e-tools for the self-management of AF. It also seeks to elicit the factors that contribute to these attitudes. METHODS Semistructured qualitative interviews with HCPs and patients were conducted to understand the interpretations and expectations of an e-tool that would be used for the self-management of AF. Interview data were analyzed using an exploratory thematic analysis approach to uncover emergent themes and infer ideas of preferred features in a device. A modified technology acceptance model was developed as a framework to help interpret these findings. Data from the HCPs and patients were compared and contrasted. RESULTS Both patients and HCPs thought that an e-tool would be useful in the self-management of AF. Although both groups favored educational content and monitoring of blood pressure, patients expressed more passivity toward self-care and an ambivalence toward the use of technology to monitor their medical condition. This appears to be related to factors such as a patient’s age, social support, and their attitudes toward technology. Instead, they favored using the app to contact their HCPs. CONCLUSIONS This study provides insights into significant differences in the attitudes of patients and HCPs toward the use of e-tools for self-care against their priorities. Understanding patients’ motivations and their needs are key to ensuring higher acceptance of such tools.

scholarly journals Understanding the Attitudes of Clinicians and Patients Toward a Self-Management eHealth Tool for Atrial Fibrillation: Qualitative Study

10.2196/15492 ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. e15492
Author(s):  
Boon Piang Cher ◽  
Gayatri Kembhavi ◽  
Kai Yee Toh ◽  
Jananie Audimulam ◽  
Wei-Yan Aloysius Chia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patient Education ◽  
Technology Acceptance ◽  
Health Care Providers ◽  
Medical Condition ◽  
Qualitative Interviews ◽  
Self Care ◽  
The Self ◽  
Self Management ◽  
Care Providers

Background Atrial fibrillation (AF) is the most common heart rhythm disorder and poses a growing disease burden worldwide because of an aging population. A multidisciplinary approach with an emphasis on patient education and self-management has been demonstrated to improve outcomes for AF through the engagement of patients in their own care. Although electronic tools (e-tools) such as apps have been proposed to provide patient education and facilitate self-management, there have been few studies to guide the development of these tools for patients with AF. Objective This study aims to explore the perceptions of patients and health care providers (HCPs) and their attitudes toward the use of e-tools for the self-management of AF. It also seeks to elicit the factors that contribute to these attitudes. Methods Semistructured qualitative interviews with HCPs and patients were conducted to understand the interpretations and expectations of an e-tool that would be used for the self-management of AF. Interview data were analyzed using an exploratory thematic analysis approach to uncover emergent themes and infer ideas of preferred features in a device. A modified technology acceptance model was developed as a framework to help interpret these findings. Data from the HCPs and patients were compared and contrasted. Results Both patients and HCPs thought that an e-tool would be useful in the self-management of AF. Although both groups favored educational content and monitoring of blood pressure, patients expressed more passivity toward self-care and an ambivalence toward the use of technology to monitor their medical condition. This appears to be related to factors such as a patient’s age, social support, and their attitudes toward technology. Instead, they favored using the app to contact their HCPs. Conclusions This study provides insights into significant differences in the attitudes of patients and HCPs toward the use of e-tools for self-care against their priorities. Understanding patients’ motivations and their needs are key to ensuring higher acceptance of such tools.

Educational and Self-Management Needs of Adults Living With Atrial Fibrillation: Perspectives of Patients, Clinicians, and Experts

2021 ◽  
Vol 30 ◽  
pp. S98
Author(s):  
C. Ferguson ◽  
L. Lombardo ◽  
L. Hickman ◽  
S. Inglis ◽  
B. Bajorek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Self Management

scholarly journals Gestational diabetes mellitus: a qualitative study of lived experiences of South Asian immigrant women and perspectives of their health care providers in Melbourne, Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mridula Bandyopadhyay
Keyword(s):  
Health Care ◽  
Gestational Diabetes ◽  
South Asian ◽  
Health Care Providers ◽  
Lived Experiences ◽  
Lifestyle Modification ◽  
Self Management ◽  
Asian Women ◽  
Care Providers ◽  
South Asian Women

Abstract Background South Asian women are at a high risk of developing gestational diabetes mellitus than other women in Australia. Gestational diabetes affects up to 14–19% of all pregnancies among South Asian, South East Asian, and Arabic populations placing women at risk of adverse pregnancy outcomes. Although, gestational diabetes resolves after childbirth, women with gestational diabetes are up to seven times more likely to develop type 2 diabetes within five to ten years of the index pregnancy. Increasingly, South Asian women are being diagnosed with gestational diabetes in Australia. Therefore, we aimed to gain a better understanding of the lived experiences of South Asian women and their experiences of self-management and their health care providers’ perspectives of treatment strategies. Methods Using an ethnographic qualitative research methodology, semi-structured one-on-one, face-to-face interviews were conducted with 21 health care providers involved in gestational diabetes management and treatment from the three largest tertiary level maternity hospitals in Melbourne, Victoria, Australia. In-depth interviews were conducted with 23 South Asian women post diagnosis between 24–28 weeks gestation in pregnancy. Results Health care providers had challenges in providing care to South Asian women. The main challenge was to get women to self-manage their blood glucose levels with lifestyle modification. Whilst, women felt self-management information provided were inadequate and inappropriate to their needs. Women felt ‘losing control over their pregnancy’, because of being preoccupied with diet and exercise to control their blood glucose level. Conclusions The gestational diabetes clinical practice at the study hospitals were unable to meet consumer expectations. Health care providers need to be familiar of diverse patient cultures, rather than applying the current ‘one size fits all’ approach that failed to engage and meet the needs of immigrant and ethnic women. Future enabling strategies should aim to co-design and develop low Glycaemic Index diet plans of staple South Asian foods and lifestyle modification messages.

“Gambling With My Cards Face Up”: Vulnerability as a Risky Act Among Men

2021 ◽  
pp. 106082652110479
Author(s):  
Florencia Durón Delfín ◽  
Rebecca B. Leach
Keyword(s):  
Lived Experiences ◽  
Qualitative Interviews ◽  
Romantic Partners ◽  
Social Conditions ◽  
Safe Space ◽  
Individual Factors ◽  
Iterative Approach ◽  
The Social ◽  
Depth Analysis ◽  
Toxic Culture

This study examines men’s lived experiences of suppressing vulnerability in a conflict. These moments of suppression happened during conflicts with friends, romantic partners, or family members. A phronetic-iterative approach guided an in-depth analysis of 16 qualitative interviews to illuminate the social conditions and expectations that prevented men from verbally expressing vulnerability. Men made sense of their own and others’ suppression patterns by naming cultural, relational, and individual factors. We argue that the toxic culture of masculinity is constructed collectively, such that men’s communication creates and reinforces expectations of what it means to be “strong” men. Reshaping the current culture into a safe space for men to express emotions will require intentional efforts from both men and their support systems.

scholarly journals Barriers to a software reminder system for risk assessment of stroke in atrial fibrillation: a process evaluation of a cluster randomised trial in general practice

2018 ◽  
Vol 68 (677) ◽  
pp. e844-e851
Author(s):  
Tim A Holt ◽  
Andrew RH Dalton ◽  
Susan Kirkpatrick ◽  
Jenny Hislop ◽  
Tom Marshall ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
General Practice ◽  
Process Evaluation ◽  
Oral Anticoagulants ◽  
Qualitative Interviews ◽  
Randomised Trial ◽  
Software Tool ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

BackgroundOral anticoagulants reduce the risk of stroke in patients with atrial fibrillation (AF), but are underused. AURAS-AF (AUtomated Risk Assessment for Stroke in AF) is a software tool designed to identify eligible patients and promote discussions within consultations about initiating anticoagulants.AimTo investigate the implementation of the software in UK general practice.Design and settingProcess evaluation involving 23 practices randomly allocated to use AURAS-AF during a cluster randomised trial.MethodAn initial invitation to discuss anticoagulation was followed by screen reminders appearing during consultations until a decision had been made. The reminders required responses, giving reasons for cases where an anticoagulant was not initiated. Qualitative interviews with clinicians and patients explored acceptability and usability.ResultsIn a sample of 476 patients eligible for the invitation letter, only 159 (33.4%) were considered suitable for invitation by their GPs. Reasons given were frequently based on frailty, and risk of falls or haemorrhage. Of those invited, 35 (22%) started an anticoagulant (7.4% of those originally identified). A total of 1695 main-screen reminders occurred in 940 patients. In 883 instances, the decision was taken not to initiate and a range of reasons offered. Interviews with 15 patients and seven clinicians indicated that the intervention was acceptable, though the issue of disruptive screen reminders was raised.ConclusionAutomated risk assessment for stroke in atrial fibrillation and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake.

New-onset atrial fibrillation and warfarin initiation: High risk periods and implications for new antithrombotic drugs

2010 ◽  
Vol 104 (12) ◽  
pp. 1099-1105 ◽  
Author(s):  
Renato D. Lopes ◽  
Elaine M. Hylek ◽  
David A. Garcia
Keyword(s):  
Atrial Fibrillation ◽  
Newly Diagnosed ◽  
Antithrombotic Drugs ◽  
Number Of Patients ◽  
Disproportionate Number ◽  
Randomised Controlled ◽  
Risk For Bleeding ◽  
Onset Atrial Fibrillation ◽  
Anticoagulant Medication ◽  
New Onset

SummaryAtrial fibrillation is a common condition that increases the risk of stroke in many patients. Although warfarin has been shown to reduce the risk of stroke, many patients who might benefit from anticoagulation do not receive this therapy. Fear of bleeding is the most often cited reason. Several new anticoagulant medications are being studied to determine their efficacy and safety relative to warfarin. Unlike earlier trials that established the superiority of warfarin over placebo, recent trials in atrial fibrillation have enrolled a disproportionate number of patients already taking warfarin. This review suggests that the risk of both haemorrhage and stroke are highest when atrial fibrillation is newly diagnosed and during the initiation of anticoagulant medication. Randomised controlled trials designed to evaluate the safety and efficacy of new anti-thrombotic agents should include substantial numbers of patients without prior exposure to anticoagulation since these individuals are at the highest risk for bleeding and thromboembolism.

OP348 Assessing The Potential Value Of Wearable Digital Health Technologies In Chronic Kidney Disease Using Early Health Technology Assessment Methods

2021 ◽  
Vol 37 (S1) ◽  
pp. 15-16
Author(s):  
Vijay S. Gc ◽  
Andrea Manca ◽  
Alexander J. Casson ◽  
Steven Antrobus ◽  
Cynthia Iglesias
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Digital Health ◽  
Qualitative Interviews ◽  
Cost Effective ◽  
Health Technology ◽  
Self Management ◽  
Health Technologies ◽  
Early Health Technology Assessment ◽  
Early Health

IntroductionWearable digital health technologies (WDHTs) offer several solutions in terms of disease monitoring, management and delivery of specific interventions. In chronic conditions, WDHTs can be used to support individuals’ self-management efforts, potentially improving adherence to (and outcomes resulting from) interventions. Early health technology assessment (HTA) methods can inform considerations about the potential clinical and economic benefits of technology in the initial phases of the product's lifecycle, facilitating identification of those Research & Development (R&D) investments with the greatest potential stakeholders’ payoff. We report our experience of using early HTA methods to support R&D decisions relating to novel WDHT being designed to support self-management of chronic kidney disease (CKD).MethodsWe performed a literature review, focus-group interviews with patients, and qualitative interviews with the prototype development team to understand the relevant characteristics of WDHTs, quantify relevant clinical indications and existing technological constraints. An early economic evaluation was used to identify the key drivers of value for money, and a discrete choice experiment shed light onto patient preferences towards what key features the WDHT should have for the users to adopt it. Then a model-based cost-effectiveness analysis was undertaken incorporating headroom analysis, return on investment, one-way sensitivity analysis and scenario analyses using data from secondary sources.ResultsThe review of the literature, focus groups with CKD patients, and qualitative interviews with technology developers helped to understand relevant characteristics of WDHT and user preferences helped inform the next R&D iteration. Compared to the standard care, WDHT that support stage ≥3 CKD patients self-management at home by measuring blood pressure and monitor mobility has the potential to be cost-effective at conventional cost-effectiveness threshold levels. From the headroom analysis, novel WDHT can be priced up to GBP280 (EUR315, USD360) and still be cost-effective compared to standard home blood pressure monitoring.ConclusionsOur study provides valuable information for the further development of the WDHT, such as defining a go/no-go decision, as well as providing a template for performing early HTA of Digital Health Interventions.

scholarly journals Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: A qualitative study

2013 ◽  
Vol 1 ◽  
pp. 205031211351000 ◽  
Author(s):  
Cassandra Kenning ◽  
Louise Fisher ◽  
Penny Bee ◽  
Peter Bower ◽  
Peter Coventry
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Self Management ◽  
Primary Care Practitioner ◽  
Patient Understanding

scholarly journals Plant Breeders' Rights Licensing in Smallholder Farming: Observations From Kenya

2018 ◽  
Vol 11 (2) ◽  
pp. 45
Author(s):  
Peter Munyi ◽  
Bram De Jonge ◽  
Neils Louwaars
Keyword(s):  
Smallholder Farmers ◽  
Qualitative Interviews ◽  
Smallholder Farming ◽  
Market Conditions ◽  
For Profit ◽  
Advantages And Disadvantages ◽  
Planting Material ◽  
Not For Profit ◽  
Wide Range ◽  
Plant Breeders Rights

Focusing on Kenya as an example of a market where food production is mostly for subsistence purposes, this article seeks to establish whether licensing of plant breeders’ rights is a mechanism that can facilitate access to seeds and planting material to smallholder farmers. Through a case study method and qualitative interviews of a wide range of stakeholders, it was found that licensing strategies that are employed in market conditions such as those prevailing in Kenya usually involve some form of market differentiation. This is in order to ensure that the targeted beneficiary is reached. It was also found that whatever licensing strategy is employed, each has some advantages and disadvantages. Further, not-for-profit technology brokers have emerged with a view to absorb some costs in the licensing process which are otherwise out of reach for smallholder farmers. Breeders also waive some of their rights with respect to protected varieties. The article concludes that the use of licensing as a tool to facilitate access to seeds and planting material for smallholder farmers in market conditions such as those prevailing in Kenya has received little attention and only involves very few commercial crops.  Where breeders choose to waive some of their rights, they should let farmers know so as to create legal certainty on utilization of accessed varieties. 

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