Patients’ and physicians’ perceptions and attitudes about oral anticoagulation and atrial fibrillation: a qualitative systematic review

BMC Family Practice

Research Article

Elisenda Sant Arderiu¹  Sandra Pequeño Saco²  Gemma Mas Dalmau²  Ivan Solà³  Pablo Alonso Coello³  María Belén Enfedaque Montes⁴ 

[1] Consorci d’Atenció Primària de Salut de l’Eixample (CAPSE), CAP Casanova, Barcelona, Spain;Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Ma Claret 167, 08025, Barcelona, Spain;Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antoni Ma Claret 167, 08025, Barcelona, Spain;CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain;Institut Català de la Salut, SAP Litoral-esquerra, Barcelona, Spain;

关键词: Atrial fibrillation;    Oral-anticoagulation therapy;    Perceptions;    Attitudes;    Patients;    Physicians;    Systematic Review;    Qualitative Research;   

DOI  :  10.1186/s12875-016-0574-0

 received in 2016-05-25, accepted in 2016-12-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundOral anticoagulant therapy reduces the risk of stroke in patients with atrial fibrillation, but many patients are still not prescribed this therapy. The causes of underuse of vitamin K antagonists oral anticoagulants are not clear but could be related, in part, to patients’ and physicians’ perceptions and attitudes towards the benefits and downsides of this treatment. The purpose of this systematic review was to evaluate and synthesize patients’ and physicians’ perceptions and attitudes towards the benefits and downsides of vitamin K antagonist, in order to explore potential factors related with its underuse.MethodsWe included studies that used qualitative or mixed methods and focused on patients’ and/or physicians’ perceptions and attitudes towards oral anticoagulation. We systematically searched PubMed, EMBASE, ISI WoK, and PsycINFO from their inception until May 2013. Two reviewers independently assessed the quality of the included studies and synthesized results using a thematic analysis approach.ResultsWe included a total of nine studies. In four studies, the quality assessed was excellent and in five was moderate. We identified three themes that were of interest to both physicians and patients: information to reinforce anticoagulation use, balance of benefits and downsides, roles in decision-making and therapy management. Three additional themes were of interest to patients: knowledge and understanding, impact on daily life, and satisfaction with therapy. The main difficulties with the use of anticoagulant treatment according to physicians were the perceived uncertainty, need of individualised decision-making, and the feeling of delegated responsibility as their main concerns. The main factors for patients were the lack of information and understanding.ConclusionPhysicians’ and patients’ perceptions and attitudes might be potential factors in the underuse of treatment with vitamin K antagonists. Improving the quality and usability of clinical guidelines, developing tools to help with the decision-making, enhancing coordination between primary care and hospital care, and improving information provided to patients could help improve the underuse of anticoagulation.

【 授权许可】

CC BY   
© The Author(s). 2017