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Reasons for non-adherence to thromboprophylaxis prescribing guidelines in atrial fibrillation in Western Australia: a qualitative descriptive study of general practitioners' views

Citation

Gebreyohannes, EA and Salter, SM and Chalmers, L and Bereznicki, L and Lee, K, Reasons for non-adherence to thromboprophylaxis prescribing guidelines in atrial fibrillation in Western Australia: a qualitative descriptive study of general practitioners' views, Thrombosis Research, 208 pp. 83-91. ISSN 0049-3848 (2021) [Refereed Article]


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DOI: doi:10.1016/j.thromres.2021.10.025

Abstract

Background: A significant proportion of the atrial fibrillation (AF) population attending Australian primary care is not receiving guideline-adherent oral anticoagulant (OAC) treatment. This study aimed to explore reasons for non-adherence to thromboprophylaxis guidelines in AF from the perspectives of general practitioners (GPs) and to map these reasons to the Capability, Opportunity, Motivation-Behaviour (COM-B) model to identify potential opportunities to support practice change.

Methods: An exploratory qualitative descriptive study among GPs practising in Western Australia was conducted using semi-structured interviews, from November 2020 to February 2021. The Framework Method was employed to facilitate thematic analysis, using NVivo software. Interview responses were also mapped to the COM-B model.

Results: Nine of the 10 GPs initially consented participated in the semi-structured interview (Male = 56%, median age = 52 years, data saturation reached with 6 participants). Two themes emerged from analysis of the interview transcripts: (1) GPs' decision-making process and (2) Patient refusal to take OACs. The COM-B model mapping identified behavioural factors that could impact adherence: capability (GPs' knowledge and understanding of AF guideline recommendations), opportunity (access to a cardiologist, and patients' refusal to take OACs), and motivation (using formal bleeding risk assessment tools).

Conclusion: GPs identified various reasons contributing to non-adherence to thromboprophylaxis guidelines in patients with AF. Multifaceted interventions should consider behavioural opportunities to improve adherence, including education and training, electronic decision support, clinical audits by allied health professionals, partnership between general practices and local hospitals, and cardiologist-led interventions to support GPs. Further studies are needed to capture patients' reasons for refusing OACs.

Item Details

Item Type:Refereed Article
Keywords:Atrial fibrillation, General practice, Guideline adherence, Oral anticoagulant, Primary care, Qualitative.
Research Division:Health Sciences
Research Group:Nursing
Research Field:Community and primary care
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Primary care
UTAS Author:Bereznicki, L (Professor Luke Bereznicki)
ID Code:152595
Year Published:2021
Web of Science® Times Cited:1
Deposited By:Pharmacy
Deposited On:2022-08-22
Last Modified:2022-08-22
Downloads:0

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