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

<h4>Background</h4>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 barr...

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Autores principales:	Anne Holbrook, Mei Wang, Marilyn Swinton, Sue Troyan, Joanne M W Ho, Deborah M Siegal
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4b98025c553f4c03b65e4bc48dfe6fba
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spelling	oai:doaj.org-article:4b98025c553f4c03b65e4bc48dfe6fba2021-12-02T20:14:02ZBarriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers.1932-620310.1371/journal.pone.0257798https://doaj.org/article/4b98025c553f4c03b65e4bc48dfe6fba2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257798https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.Anne HolbrookMei WangMarilyn SwintonSue TroyanJoanne M W HoDeborah M SiegalPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257798 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Anne Holbrook Mei Wang Marilyn Swinton Sue Troyan Joanne M W Ho Deborah M Siegal Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
format	article
author	Anne Holbrook Mei Wang Marilyn Swinton Sue Troyan Joanne M W Ho Deborah M Siegal
author_facet	Anne Holbrook Mei Wang Marilyn Swinton Sue Troyan Joanne M W Ho Deborah M Siegal
author_sort	Anne Holbrook
title	Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers.
title_short	Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers.
title_full	Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers.
title_fullStr	Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers.
title_full_unstemmed	Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers.
title_sort	barriers and facilitators for optimizing oral anticoagulant management: perspectives of patients, caregivers, and providers.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/4b98025c553f4c03b65e4bc48dfe6fba
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Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers.

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