title: Needs and barriers to improve the collaboration in oral anticoagulant therapy: a qualitative study.
abstract: BACKGROUND
  Oral anticoagulant therapy (OAT) involves many health care disciplines. Even though collaboration between care professionals is assumed to improve the quality of OAT, very little research has been done into the practice of OAT management to arrange and manage the collaboration. This study aims to identify the problems in collaboration experienced by the care professionals involved, the solutions they proposed to improve collaboration, and the barriers they encountered to the implementation of these solutions.
  
  
  METHODS
  In the Netherlands, intensive follow-up of OAT is provided by specialized anticoagulant clinics (ACs). Sixty-eight semi-structured face-to-face interviews were conducted with 103 professionals working at an AC. These semi-structured interviews were transcribed verbatim and analysed inductively. Wagner's chronic care model (CCM) and Cabana's framework for improvement were used to categorize the results.
  
  
  RESULTS
  AC professionals experienced three main bottlenecks in collaboration: lack of knowledge (mostly of other professionals), lack of consensus on OAT, and limited information exchange between professionals. They mentioned several solutions to improve collaboration, especially solutions of CCM's decision support component (i.e. education, regular meetings, and agreements and protocols). Education is considered a prerequisite for the successful implementation of other proposed solutions such as developing a multidisciplinary protocol and changing the allocation of tasks. The potential of the health care organization to improve collaboration seemed to be underestimated by professionals. They experienced several barriers to the successful implementation of the proposed solutions. Most important barriers were the lack motivation of non-AC professionals and lack of time to establish collaboration.
  
  
  CONCLUSIONS
  This study revealed that the collaboration in OAT is limited by a lack of knowledge, a lack of consensus, and a limited information exchange. Education was identified as the best way to improve collaboration and considered a prerequisite for a successful implementation of other proposed solutions. Hence, the implementation sequence is of importance in order to improve the collaboration successfully. First step is to establish alignment regarding collaboration with all involved professionals to encounter the lack of motivation of non-AC professionals and lack of time.
authors.affiliation: Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands. hanneke.drewes@rivm.nl
authors.forename: Hanneke W
authors.initials: HW
authors.lastname: Drewes
authors.forename: Mattijs S
authors.initials: MS
authors.lastname: Lambooij
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.forename: Bert R
authors.initials: BR
authors.lastname: Meijboom
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Graafmans
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D005500:Follow-Up Studies; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D009426:Netherlands; D036301:Qualitative Research
chemical_list: D000925:Anticoagulants