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Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review


Gebreyohannes, EA and Mill, D and Salter, S and Chalmers, L and Bereznicki, L and Lee, K, Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review, Thrombosis Research, 205 pp. 128-136. ISSN 0049-3848 (2021) [Refereed Article]

Copyright Statement

2021 Elsevier Ltd. All rights reserved.

DOI: doi:10.1016/j.thromres.2021.07.014


Background: Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting.

Methods: A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study.

Results: A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective.

Conclusions: Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.

Item Details

Item Type:Refereed Article
Keywords:atrial fibrillation, guideline, adherence, atrial fibrillation, anticoagulants, quality improvement, interventions, primary health care
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacology and therapeutics
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Bereznicki, L (Professor Luke Bereznicki)
ID Code:145657
Year Published:2021
Web of Science® Times Cited:2
Deposited By:Pharmacy
Deposited On:2021-07-29
Last Modified:2021-09-16

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