Supporting patients to self-monitor their oral anticoagulation therapy: recommendations based on a qualitative study of patients' experiences

Br J Gen Pract. 2015 Jul;65(636):e438-46. doi: 10.3399/bjgp15X685645. Epub 2015 Jun 15.

Abstract

Background: Clinical trials suggest that oral anticoagulation therapy (OAT) self-monitoring is safe and effective, however little is known about the patient experience of this process. There is a lack of understanding about how best to train and support patients embarking on OAT self-monitoring.

Aim: To collect in-depth information about patients' experiences of OAT self-monitoring outside of clinical trial conditions and to produce a set of recommendations on how best to support such patients.

Design and setting: Semi-structured qualitative interviews with patients who self-monitor and live in England.

Method: In total, 26 of the 267 (9.7%) who participated in the Cohort study of Anticoagulation Self-Monitoring (CASM) and were still self-monitoring after 12 months' follow-up were interviewed. Topics discussed included experiences of OAT self-monitoring, healthcare support, training, and decision making. Framework analysis was used.

Results: Following initial problems using the monitoring device, interviewees described a mostly positive experience. Although less effort was expended attending monitoring appointments with health professionals, effort was required to conduct self-monitoring tests and to interpret and act on the results. Desire to self-manage was variable, especially when dosing advice systems worked promptly and reliably. Interviewees overcame patchy healthcare system knowledge and support of self-monitoring by educating themselves. Family and friends provided support with learning to use the monitor and managing OAT dosage adjustments.

Conclusion: Better, more-consistent training and health-service support would have alleviated a number of problems encountered by these patients who were self-monitoring. This training and support will become even more important if self-monitoring becomes more accessible to the general population of people on OAT.

Keywords: anticoagulants; primary care; qualitative research; self-management; self-monitoring.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Aftercare
  • Aged
  • Anticoagulants / administration & dosage*
  • Drug Monitoring / methods*
  • Drug Monitoring / standards
  • England / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • International Normalized Ratio
  • Male
  • Middle Aged
  • Patient Education as Topic / organization & administration*
  • Primary Health Care / organization & administration*
  • Qualitative Research*
  • Self Care
  • Stroke / epidemiology
  • Stroke / prevention & control*
  • Surveys and Questionnaires*
  • Time Factors

Substances

  • Anticoagulants