More blood, sweat and tears: a qualitative analysis of warfarin management after discharge from hospital
Stafford, L and Peterson, GM and Bereznicki, LRE and Jackson, SL and Bajorek, B and DeBoos, I, More blood, sweat and tears: a qualitative analysis of warfarin management after discharge from hospital, SHPA 35th National Conference Handbook and book of abstracts, 5-8 November 2009, Perth Convention Exhibition Centre WA, pp. 184. (2009) [Conference Extract]
Aim: Warfarin management remains a major therapeutic challenge, especially in the immediate post-discharge period.
This qualitative study aimed firstly to identify the benefits and deficiencies of existing post-discharge warfarin management
processes; and secondly to investigate the barriers to, and facilitators of, the implementation of a new, best practice
post-discharge warfarin service currently being developed by the project team.
Methods: Purposive, criterion-based sampling was utilised within Tasmania, New South Wales and the Australian Capital
Territory to recruit patients recently discharged from hospital on warfarin and a range of healthcare providers involved in
their care. The latter included general practitioners, haematologists, pharmacists and nurses, and representatives from their
professional bodies. Between August and October 2008, 47 in-depth, semi-structured telephone interviews were conducted
using standard discussion guides. Data were thematically analysed using a phenomenological framework.
Results: Respondents identified the existence of 'ideal' discharge procedures for patients on warfarin, but current poor
compliance to these processes. Desirable features of a post-discharge service included effective communication at the
continuum of care, with timely and complete transfer of discharge information, and facilitation of early community followup.
The potential benefits of more patient-friendly warfarin education material, improved opportunities for reinforcement
of warfarin education, a home-delivered service and a home medicines review were also recognised. There was general
support for the proposed post-discharge service model, although concerns were raised regarding issues of remuneration
and the sustainability of the service.
Conclusion: Deficiencies in the current post -discharge processes for patients on warfarin were acknowledged as placing
them at risk of medication misadventure. A new post-discharge service has the potential to address many of these problems,
although this analysis highlighted some potential barriers to its implementation which will be further addressed in the next
phase of the project.