Anticoagulant usage for primary stroke prevention: a general practitioner survey in local areas of metropolitan Sydney.
We assessed the hypothesis that having a non-English-speaking background (NESB), being very elderly, living alone, and having cognitive impairment were contributing factors to anticoagulant under-utilisation for atrial fibrillation in our local community. A questionnaire was mailed to 532 general practitioners (GPs) in three areas of metropolitan Sydney, Australia. The questionnaire included five case scenarios, regarding either an English-speaking background (ESB) patient, or an NESB patient, each characterised by potential barrier(s) for anticoagulant usage: being (1) elderly; (2) elderly with mild dementia; (3) elderly with mild dementia and living alone; (4) elderly with severe dementia; and (5) very elderly. The overall response rate was 34%. The percentage of GPs recommending anticoagulation was 57%, 50%, 6%, 25% and 23%, respectively, for the ESB scenario, and 48%, 32%, 4%, 14% and 18%, respectively, for the NESB scenario. Eighty-eight percent of GPs rated 'adherence to International Normalized Ration monitoring' as 'very important' in their decision. In conclusion, the factors proposed in our hypothesis were associated with a lower likelihood for anticoagulant prescription for atrial fibrillation.
Shen
Qing
Q
Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Locked Bag 1600, Bankstown, New South Wales 2200, Australia. qing.shen@swsahs.nsw.gov.au
Cordato
Dennis
D
Ng
Jude
J
Hung
Wai Tak
WT
Kokkinos
James
J
Karr
Margaret
M
Yin Chan
Daniel Kam
DK
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control*; D011795:Surveys and Questionnaires
D000925:Anticoagulants