Barriers and enablers to healthcare system uptake of direct oral anticoagulants for stroke prevention in atrial fibrillation: a qualitative interview study with healthcare professionals and policy makers in England

ObjectiveTo better understand the factors influencing the uptake of direct oral anticoagulants (DOACs) across different health economies in National Health Service England from the perspective of health professionals and other health economy stakeholders.DesignQualitative interview study using a cri...

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Vydáno v:BMJ open Ročník 13; číslo 4; s. e069575
Hlavní autoři: Medlinskiene, Kristina, Richardson, Susan, Petty, Duncan, Stirling, Katherine, Fylan, Beth
Médium: Journal Article
Jazyk:angličtina
Vydáno: England British Medical Journal Publishing Group 25.04.2023
BMJ Publishing Group LTD
BMJ Publishing Group
Edice:Original research
Témata:
Administration, Oral
Administrative Personnel
Anticoagulants
Anticoagulants - therapeutic use
anticoagulation
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Cardiac arrhythmia
cardiology
Data analysis
Delivery of Health Care
England
Health services
Hospitals
Humans
Innovations
Interviews
Medical personnel
Medicine
organisation of health services
Patient-centered care
Patients
Pharmaceutical industry
Public health
Qualitative Research
State Medicine
Stroke
Stroke - drug therapy
Stroke - prevention & control
stroke medicine
Systematic review
England
United Kingdom > UK
stroke medicine
organisation of health services
cardiology
anticoagulation
ISSN:2044-6055, 2044-6055
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Popis
Shrnutí:ObjectiveTo better understand the factors influencing the uptake of direct oral anticoagulants (DOACs) across different health economies in National Health Service England from the perspective of health professionals and other health economy stakeholders.DesignQualitative interview study using a critical realism perspective and informed by the Diffusion of Innovations in Service Organisations model.SettingThree health economies in the North of England, United Kingdom.ParticipantsHealthcare professionals involved in the management of patients requiring oral anticoagulants, stakeholders involved in the implementation of DOACs and representatives of pharmaceutical industry companies and patient support groups.InterventionSemistructured interviews (face-to-face or telephone) were conducted with 46 participants. Interviews were analysed using the Framework method.ResultsIdentified factors having an impact on the uptake of DOACs were grouped into four themes: perceived value of the innovation, clinician practice environment, local health economy readiness for change, and the external health service context. Together, these factors influenced what therapy options were offered and prescribed to patients with atrial fibrillation. The interviews also highlighted strategies used to improve or restrict the uptake of DOACs and tensions between providing patient-centred care and managing financial implications for commissioners.ConclusionsThe findings contribute to the wider literature by providing a new and in-depth understanding on the uptake of DOACs. The findings may be applicable to other new medicines used in chronic health conditions.
Bibliografie:Original research
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SourceType-Scholarly Journals-1
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2022-069575