Management of warfarin in atrial fibrillation: views of health professionals, older patients and their carers.
OBJECTIVE
To identify the views of health professionals, patients and their carers on strategies to improve the use and management of warfarin in older patients with atrial fibrillation.


METHODS
Qualitative study based on analysis of group interviews.


METHODS
A major metropolitan teaching hospital, from 1 March to 30 April 2003.


METHODS
14 patients (>/= 65 years) with established atrial fibrillation and taking warfarin, three carers, 12 specialists, eight general practitioners, six community pharmacists, nine hospital pharmacists, and 11 nurses volunteered in response to flyers promoting the study.


RESULTS
Suggested strategies to improve warfarin management targeted support services for GPs and patients. Hospital-based clinicians felt that dissemination of trial evidence to GPs to support treatment recommendations is required, and that GPs need to enlist allied health professionals in the management of patients taking warfarin. GPs preferred access to practical advice from expert colleagues on the day-to-day management. Patients requested more information about warfarin therapy, as access to information is inadequate, particularly from primary sources (GPs, community pharmacists). Verbal and written information are equally important, but a single counselling session or supply of a booklet was viewed as inadequate. Participants identified various interventions for all levels of warfarin management; from the collective input, a framework for management strategies was developed.


CONCLUSIONS
Health professionals and patients require more customised information to support warfarin use and management.
Bajorek
Beata V
BV
Faculty of Pharmacy, University of Sydney, Sydney, NSW. beatab@pharm.usyd.edu.au
Ogle
Susan J
SJ
Duguid
Margaret J
MJ
Shenfield
Gillian M
GM
Krass
Ines
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002309:Cardiology; D017028:Caregivers / Q000523:psychology; D003657:Decision Making; D016903:Drug Monitoring; D005260:Female; D005851:Geriatric Nursing; D006297:Health Services Accessibility; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology; D010594:Pharmacies; D010595:Pharmacists / Q000523:psychology; D010607:Pharmacy Service, Hospital; D010820:Physicians / Q000523:psychology; D010821:Physicians, Family / Q000523:psychology; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin