Warfarin management after discharge from hospital: a qualitative analysis.
OBJECTIVE
Warfarin is recognized as a high-risk medication for adverse events, and the risks are particularly heightened in the period immediately following a patient's discharge from hospital. This qualitative study aimed to explore the experiences of Australian patients and healthcare professionals of warfarin management in the post-discharge period and identify the benefits and deficiencies of existing systems, to inform the development of a model for a new collaborative post-discharge warfarin management service.


METHODS
Healthcare professionals, professional organization representatives and patients recently discharged from hospital taking warfarin (consumers) were recruited via purposive, criterion-based sampling within two Australian states. Semi-structured telephone interviews were conducted between August and October 2008 using standard discussion guides. Data were manually analyzed to identify emergent themes using a phenomenological approach.


RESULTS
Forty-seven participants were involved in the telephone interviews. Three major themes emerged: (i) appropriate warfarin education is integral to effective warfarin management, (ii) problems occur in communication along the continuum of care and (iii) home-delivered services are valuable to both patients and healthcare professionals.


CONCLUSIONS
Although high-quality warfarin education and effective communication at the hospital-community interface were identified as important in post-discharge warfarin management, deficiencies were perceived within current systems. The role of home-delivered services in ensuring timely follow-up and promoting continuity of care was recognized. Previous studies exploring anticoagulation management in other settings have identified similar themes. Post-discharge management should therefore focus on providing patients with a solid foundation to minimize future problems.


CONCLUSIONS
Addressing the three identified facets of care within a new, collaborative post-discharge warfarin management service may address the perceived deficiencies in existing systems. Improvements may result in the short- and longer-term health outcomes of patients discharged from hospital taking warfarin, including a reduction in their risk of adverse events.
Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tas., Australia. leanne.stafford@utas.edu.au
L
L
Stafford
E C
EC
van Tienen
G M
GM
Peterson
L R E
LR
Bereznicki
S L
SL
Jackson
B V
BV
Bajorek
J R
JR
Mullan
I M
IM
DeBoos
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards; D003625:Data Collection; D016903:Drug Monitoring / Q000379:methods; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000379:methods*; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin