title: Anticoagulated patient's perception of their illness, their beliefs about the anticoagulant therapy prescribed and the relationship with adherence: impact of novel oral anticoagulant therapy - study protocol for The Switching Study: a prospective cohort study.
abstract: BACKGROUND
  Anticoagulant therapy is prescribed for millions of patients worldwide for the prevention and treatment of both arterial and venous thrombosis. Historically, only vitamin K antagonists have been available for clinicians to prescribe. The anticoagulation landscape is changing. The recent availability of the novel oral anticoagulants overcome many of the disadvantages associated with vitamin K antagonists. However the lack of formal monitoring and clinic follow-up is a concern for clinicians, as medication adherence is being assumed, which is known to decline in patients prescribed medications for chronic conditions. The switching study is a programme of work investigating the association between medication adherence and patient's beliefs about anticoagulation therapy (warfarin and subsequently novel oral anticoagulants), together with beliefs about their illness and anticoagulation related quality of life.
  
  
  METHODS
  The anticoagulation database at King's College Hospital will be interrogated and two groups of patients will be identified; those with a time in therapeutic range on warfarin of ≥75 % and those <50 %. These groups of patients will have their illness perceptions, anticoagulation specific quality of life and beliefs about medications compared. Those patients in the time in therapeutic range <50 % group, will be then be invited to switch to a novel oral anticoagulant, as per local guidance. Those patients, who do switch, will then be followed longitudinally and have their adherence, illness perceptions, anticoagulation specific quality of life and beliefs about medications, re-evaluated on the novel agent. The results from these sub-studies, will inform a clinical pathway to support patients on these novel agents, which will be evaluated in an independent group of patients.
  
  
  CONCLUSIONS
  The results from the switching study will be used to develop a clinical pathway to support patient's prescribed novel oral anticoagulant therapy long-term.
authors: Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King's College London, 5th Floor, Franklin-Wilkins Building, London, SE1 9NH UK.
authors: Vivian
authors: V
authors: Auyeung
authors: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK ; Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King's College London, 5th Floor, Franklin-Wilkins Building, London, SE1 9NH UK.
authors: Jignesh P
authors: JP
authors: Patel
authors: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK ; Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King's College London, 5th Floor, Franklin-Wilkins Building, London, SE1 9NH UK.
authors: John K
authors: JK
authors: Abdou
authors: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
authors: Bipin
authors: B
authors: Vadher
authors: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
authors: Lynda
authors: L
authors: Bonner
authors: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
authors: Alison
authors: A
authors: Brown
authors: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
authors: Lara N
authors: LN
authors: Roberts
authors: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
authors: Raj K
authors: RK
authors: Patel
authors: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
authors: Roopen
authors: R
authors: Arya
keywords: Anticoagulants; Atrial fibrillation; Beliefs; Illness perceptions; Medication adherence; Quality of life; Venous thromboembolism