School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.
Department of Medicine, Raigmore Hospital, Inverness, UK.
Br J Clin Pharmacol. 2019 Oct;85(10):2414-2422. doi: 10.1111/bcp.14069. Epub 2019 Aug 2.
A recent systematic review highlighted the lack of robust studies on prescribers' perspectives of direct-acting oral anticoagulants (DOACs) for nonvalvular atrial fibrillation. The aim was to determine prescribers' views and experiences of prescribing DOACs.
A cross-sectional survey of prescribers in a remote and rural area of Scotland. Survey items were: demographics; prescribing of DOACs; views of potential influences on DOAC prescribing; knowledge of prescribing guidelines; and experiences. Items on potential influences were based on the Theoretical Domains Framework. Data were analysed using descriptive and inferential statistics, and content analysis of responses to open questions. Principal component analysis was performed on the items of potential influences.
In total, 154 responses were received, 120 (77.9%) from doctors, 18 (11.7%) from nurse prescribers and 10 (6.4%) from pharmacist prescribers (6 missing). Principal component analysis of the Theoretical Domains Framework items of potential influences gave 4 components. Component scores for (i) role of professionals, their knowledge and skills and (ii) influences on prescribing were positive. Those for (iii) consequences of prescribing and (iv) monitoring for safety and effectiveness were more neutral. There were low levels of agreement for statements relating to DOACs being more effective, safer and cost-effective than warfarin. There were similar responses around the complexity of bleeding management and detection of over and under-anticoagulation.
This study has identified several key issues of DOAC prescribing (e.g. bleeding management) hence further emphasis is required in continuing professional development and during guideline implementation and evaluation.
最近的一项系统评价强调了缺乏关于直接作用的口服抗凝剂（DOACs）用于非瓣膜性心房颤动的处方医生观点的稳健研究。目的是确定处方医生对开具 DOAC 的看法和经验。
对苏格兰偏远农村地区的处方医生进行横断面调查。调查项目包括：人口统计学信息；DOAC 的开具情况；对可能影响 DOAC 开具的因素的看法；对开具指南的了解程度；以及经验。潜在影响因素的项目基于理论领域框架。使用描述性和推断性统计以及对开放性问题的内容分析来分析数据。对潜在影响因素的项目进行主成分分析。
共收到 154 份回复，其中 120 份（77.9%）来自医生，18 份（11.7%）来自护士处方者，10 份（6.4%）来自药剂师处方者（6 份缺失）。潜在影响因素的理论领域框架项目的主成分分析给出了 4 个组成部分。专业人员角色、他们的知识和技能以及（ii）对处方的影响的组成部分得分是积极的。（iii）处方的后果和（iv）监测安全性和有效性的组成部分得分则更为中性。与 DOAC 比华法林更有效、更安全和更具成本效益的说法存在低水平的一致性。关于出血管理和检测过度和不足抗凝的复杂性，也存在类似的反应。
本研究确定了 DOAC 开具处方的几个关键问题（例如出血管理），因此需要在继续专业发展以及在指南实施和评估过程中进一步强调。
