Wang Yishen, Bajorek Beata
Graduate School of Health-Pharmacy, The University of Technology Sydney, Sydney, NSW, 2007, Australia.
Department of Pharmacy, Royal North Shore Hospital, Sydney, NSW, Australia.
Int J Clin Pharm. 2016 Aug;38(4):985-95. doi: 10.1007/s11096-016-0329-y. Epub 2016 Jun 10.
Background For stroke prevention in patients with atrial fibrillation (AF), the decision-making around antithrombotic therapy has been complicated by older age, multiple comorbidities, polypharmacy and the different pharmacological properties of warfarin and the nonvitamin K antagonist oral anticoagulants (NOACs). The complexity of decision-making has been associated with a reluctance by health professionals to use antithrombotic therapy, leading to poor clinical outcomes. In order to improve stroke prevention in patients with AF, the contemporary perspectives of health professionals on the decision-making around antithrombotic therapy needs exploration. Objective To elicit emerging themes describing health professionals' perspectives on the decision-making around antithrombotic therapy for stroke prevention in patients with AF. Setting Sydney metropolitan area of New South Wales, Australia. Method A qualitative study based on face-to-face interviews was conducted from August to October 2014. Seven pharmacists, seven specialists, six general practitioners and six nurses practising in the Sydney metropolitan area and managing antithrombotic therapy for AF were interviewed until theme saturation was achieved in each subgroup. Interview transcripts were analysed using manual inductive coding. Main outcome measure Emerging themes describing health professionals' perspectives on the decision-making around antithrombotic therapy for stroke prevention in patients with AF. Results Three overarching themes emerged. (1) Comprehensive assessment is necessary for decision-making but is not always implemented. Health professionals mostly focused on stroke risk assessment, not on the bleeding risk and medication safety issues. (2) Health professionals from different disciplines have different preferences for antithrombotic therapies. Although the majority of health professionals considered warfarin as the first-line therapy, NOACs were preferred by neurologists and haematologists. (3) Health professionals focused on different aspects of the decision making process: GPs and specialists were concerned about the appropriate prescription of antithrombotics, while pharmacists and nurses focused on daily medication management by patients. Conclusion The decision-making process appears to be partially preference based rather than systematic, and health professionals from various disciplines focus on different parts of the decision-making process.
背景 对于心房颤动（AF）患者的卒中预防，抗栓治疗的决策因患者年龄较大、合并多种疾病、服用多种药物以及华法林和非维生素K拮抗剂口服抗凝药（NOACs）不同的药理特性而变得复杂。决策的复杂性导致医疗专业人员不愿使用抗栓治疗，进而导致临床结局不佳。为了改善AF患者的卒中预防，需要探索医疗专业人员对抗栓治疗决策的当代观点。
目的 找出描述医疗专业人员对AF患者卒中预防抗栓治疗决策观点的新出现主题。
地点 澳大利亚新南威尔士州悉尼大都市地区。
方法 2014年8月至10月进行了一项基于面对面访谈的定性研究。对悉尼大都市地区从事AF抗栓治疗管理的7名药剂师、7名专科医生、6名全科医生和6名护士进行了访谈，直至每个亚组达到主题饱和。使用手工归纳编码分析访谈记录。
主要结局指标 描述医疗专业人员对AF患者卒中预防抗栓治疗决策观点的新出现主题。
结果 出现了三个总体主题。（1）决策需要全面评估，但并非总是得到实施。医疗专业人员大多关注卒中风险评估，而非出血风险和药物安全问题。（2）不同学科的医疗专业人员对抗栓治疗有不同偏好。虽然大多数医疗专业人员认为华法林是一线治疗，但神经科医生和血液科医生更倾向于使用NOACs。（3）医疗专业人员关注决策过程的不同方面：全科医生和专科医生关心抗栓药物的适当处方，而药剂师和护士则关注患者的日常用药管理。
结论 决策过程似乎部分基于偏好而非系统，不同学科的医疗专业人员关注决策过程的不同部分。
