Use of DOACs in primary care: an integration of patient and practitioner perspectives

Background Elderly patients with atrial fibrillation (AF) are increasingly offered direct oral anticoagulants (DOACs) to reduce the risk of catastrophic stroke but still require clinical follow-up and compliance check to maintain patient safety. Although a recent qualitative meta-analysis has explored up to date research in this area,1 little is known qualitatively, in the United Kingdom, about clinicians’ or patients’ views and experiences of DOAC use in primary care.

Aim To understand the experiences of healthcare practitioners and patients in relation to DOAC use in primary care.

Design & setting Semi-structured interviews were undertaken. Sixteen elderly AF patients taking DOACs, ten pharmacists and six general practitioners (GPs) were interviewed in Sheffield in 2018.

Method Interview questions were developed from a systematic literature review. Interviews were audio-recorded, transcribed, and analysed using six stage thematic analysis.

Results The integrated perspectives show that all three participant groups preferred DOACs over warfarin- driven mainly by the safety profile compared to warfarin. GPs valued pharmacists input in anticoagulant care and pharmacists discussed patient safety in the context of anticoagulant audits and highlighted the need for continuous patient education and counselling. Medication reviews by pharmacists was seen as a positive contribution to medicines optimisation.

Conclusion Patients had an overriding trust in their doctors. GPs valued a collaborative approach with other clinicians and community pharmacists appeared to highlight operational challenges in primary care which may limit the effectiveness of interventions.