title: Supporting patients to self-monitor their oral anticoagulation therapy: recommendations based on a qualitative study of patients' experiences.
abstract: BACKGROUND
  Clinical trials suggest that oral anticoagulation therapy (OAT) self-monitoring is safe and effective, however little is known about the patient experience of this process. There is a lack of understanding about how best to train and support patients embarking on OAT self-monitoring.
  
  
  OBJECTIVE
  To collect in-depth information about patients' experiences of OAT self-monitoring outside of clinical trial conditions and to produce a set of recommendations on how best to support such patients.
  
  
  METHODS
  Semi-structured qualitative interviews with patients who self-monitor and live in England.
  
  
  METHODS
  In total, 26 of the 267 (9.7%) who participated in the Cohort study of Anticoagulation Self-Monitoring (CASM) and were still self-monitoring after 12 months' follow-up were interviewed. Topics discussed included experiences of OAT self-monitoring, healthcare support, training, and decision making. Framework analysis was used.
  
  
  RESULTS
  Following initial problems using the monitoring device, interviewees described a mostly positive experience. Although less effort was expended attending monitoring appointments with health professionals, effort was required to conduct self-monitoring tests and to interpret and act on the results. Desire to self-manage was variable, especially when dosing advice systems worked promptly and reliably. Interviewees overcame patchy healthcare system knowledge and support of self-monitoring by educating themselves. Family and friends provided support with learning to use the monitor and managing OAT dosage adjustments.
  
  
  CONCLUSIONS
  Better, more-consistent training and health-service support would have alleviated a number of problems encountered by these patients who were self-monitoring. This training and support will become even more important if self-monitoring becomes more accessible to the general population of people on OAT.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Alice
authors.initials: A
authors.lastname: Tompson
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Carl
authors.initials: C
authors.lastname: Heneghan
authors.affiliation: University of Birmingham, Edgbaston.
authors.forename: David
authors.initials: D
authors.lastname: Fitzmaurice
authors.affiliation: Institute of Public Health, University of Cambridge, Cambridge.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sutton
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Sian
authors.initials: S
authors.lastname: Harrison
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Alison
authors.initials: A
authors.lastname: Ward
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000359:Aftercare; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012648:Self Care; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000925:Anticoagulants
keywords: anticoagulants; primary care; qualitative research; self-management; self-monitoring