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Research Article
Shera Chaterji
SingHealth Polyclinics
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Oral anticoagulant therapy use in patients with atrial fibrillation (AF) remains suboptimal despite the availability of both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs). Primary care physicians’ (PCP) decision-making to initiate and select appropriate anticoagulant medication is pivotal in reducing complications among patients with AF.
Aim: This study explored the factors influencing PCPs’ decision-making in anticoagulant initiation and adjustment for patients with non-valvular AF.
Design of study: Qualitative research based on the theoretical framework of the Generalist Wheel of Knowledge, Understanding and Inquiry.
Method: In-depth interviews or focus group discussions were conducted with 27 PCPs in general practice in urban Singapore. The audio-recordings were transcribed, audited and coded to identify themes, which are framed according to the “clinician”, “patient”, “medical condition and treatment” and “healthcare system and policy” domains.
Results: Personal training and experience with anticoagulant therapy; understanding patient risk-stratification; AF detection during clinical practice; medication cost; clinical support services for anticoagulation monitoring and constraints in existing care model influenced PCPs in their anticoagulant prescription. PCPs preferred to seek guidance from cardiologists in managing patients with newly diagnosed AF and attempted to engage their patients in decision-making regarding anticoagulant therapy. They perceived sub-specialized primary care clinics focusing on AF co-management with cardiologists as an ideal setting for initiation and maintenance of anticoagulant therapy.
Conclusion: PCPs’ decisions on anticoagulant therapy is influenced by personal attributes, patients, clinical presentations, anticoagulant properties and healthcare system. Their proposed care model to address the barriers awaits feasibility and acceptance assessment in future research.
Keywords
anticoagulants, prescribing, primary care physicians, atrial fibrillation
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Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 18 Jan, 2021
No community comments so far
Editorial decision: Major revision
On 25 Mar, 2021
Reviews received
Received 18 Mar, 2021
Reviewers agreed
On 07 Mar, 2021
Reviewers agreed
On 01 Mar, 2021
Reviewers invited
Invitations sent on 28 Jan, 2021
Editor assigned
On 28 Jan, 2021
Editor invited
On 12 Jan, 2021
Submission checks complete
On 12 Jan, 2021
First submitted
On 11 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
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A new preprint design is coming!
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This preprint is under consideration at BMC Primary Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Shera Chaterji
SingHealth Polyclinics
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 18 Jan, 2021
No community comments so far
Editorial decision: Major revision
On 25 Mar, 2021
Reviews received
Received 18 Mar, 2021
Reviewers agreed
On 07 Mar, 2021
Reviewers agreed
On 01 Mar, 2021
Reviewers invited
Invitations sent on 28 Jan, 2021
Editor assigned
On 28 Jan, 2021
Editor invited
On 12 Jan, 2021
Submission checks complete
On 12 Jan, 2021
First submitted
On 11 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Oral anticoagulant therapy use in patients with atrial fibrillation (AF) remains suboptimal despite the availability of both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs). Primary care physicians’ (PCP) decision-making to initiate and select appropriate anticoagulant medication is pivotal in reducing complications among patients with AF.
Aim: This study explored the factors influencing PCPs’ decision-making in anticoagulant initiation and adjustment for patients with non-valvular AF.
Design of study: Qualitative research based on the theoretical framework of the Generalist Wheel of Knowledge, Understanding and Inquiry.
Method: In-depth interviews or focus group discussions were conducted with 27 PCPs in general practice in urban Singapore. The audio-recordings were transcribed, audited and coded to identify themes, which are framed according to the “clinician”, “patient”, “medical condition and treatment” and “healthcare system and policy” domains.
Results: Personal training and experience with anticoagulant therapy; understanding patient risk-stratification; AF detection during clinical practice; medication cost; clinical support services for anticoagulation monitoring and constraints in existing care model influenced PCPs in their anticoagulant prescription. PCPs preferred to seek guidance from cardiologists in managing patients with newly diagnosed AF and attempted to engage their patients in decision-making regarding anticoagulant therapy. They perceived sub-specialized primary care clinics focusing on AF co-management with cardiologists as an ideal setting for initiation and maintenance of anticoagulant therapy.
Conclusion: PCPs’ decisions on anticoagulant therapy is influenced by personal attributes, patients, clinical presentations, anticoagulant properties and healthcare system. Their proposed care model to address the barriers awaits feasibility and acceptance assessment in future research.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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