Introduction: Patients with atrial fibrillation (AF) are up to six times greater risk of stroke than those without. However, management of AF remains sub-optimal. Long-term oral anticoagulation with warfarin is an effective treatment for reducing the risk of stroke in af but due to a variable pharmacokinetic profile and narrow therapeutic range, routine monitoring of warfarin is required.
Self-monitoring is one intervention that has been proposed to improve the quality of anticoagulation control; it has a strong evidence base and is recommended by NICE. It enables patients to test their own INR and report the result to clinicians for dose adjustment through a number of contact routes. The aim of this qualitative evaluation was to explore the acceptability and practicalities of the introduction of a self-monitoring service across both primary and secondary care.
Method: Five GP practices and one hospital in Lancashire implementing a new self-monitoring of warfarin service, invited participating patients and staff to attend a focus group or interview.
Seventeen patients and 13 staff participated across two secondary care interviews, and one HCP interview, two patient and two HCP focus groups in primary care. Thematic analysis was conducted on transcripts in NVIVO by three of the authors. Coding was then compared and discussed until consensus on the themes was achieved.
Results: Key themes around flexibility and freedom, resources, reassurance and contact, and selection were identified. Staff and patients recognised, and were positive about, the flexibility and convenience the intervention provided. However, health care professionals (HCPs), and to a lesser extent, patients, highlighted that clinical and technical support was still required, resulting in in less than anticipated time savings. Both staff and patients felt that participants needed considered selection to maximise benefit and engagement. Patients quickly learned to
self-monitor to provide self-reassurance, and so often did more than the scheduled readings.