Practices, beliefs, and attitudes of clinicians in prescribing direct oral anticoagulants for obese adults with atrial fibrillation: a qualitative study.

Autor: Shaikh F; School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia. fs940@uowmail.edu.au., Wynne R; School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia.; The Royal Melbourne Hospital, Parkville, VIC, Australia., Castelino RL; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.; Pharmacy Department, Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia., Inglis SC; Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, NSW, Australia., Davidson PM; University of Wollongong, Wollongong, NSW, Australia., Ferguson C; School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia.
Jazyk: angličtina
Zdroj: International journal of clinical pharmacy [Int J Clin Pharm] 2023 Aug; Vol. 45 (4), pp. 962-969. Date of Electronic Publication: 2023 May 30.
DOI: 10.1007/s11096-023-01583-z
Abstrakt: Background: Atrial fibrillation (AF) and obesity affect over 60 and 650 million people, respectively.
Aim: This study aimed to explore clinician practices, beliefs, and attitudes towards the use of direct oral anticoagulants (DOACs) in obese adults (BMI ≥ 30 kg/m 2 ) with AF.
Method: Semi-structured interviews via video conference were conducted with multidisciplinary clinicians from across Australia, with expertise in DOAC use in adults with AF. Clinicians were invited to participate using purposive and snowball sampling techniques. Data were analysed in NVIVO using thematic analysis.
Results: Fifteen clinicians including cardiologists (n = 5), hospital and academic pharmacists (n = 5), general practitioners (n = 2), a haematologist, a neurologist and a clinical pharmacologist participated. Interviews were on average 31 ± 9 min. Key themes identified were: Health system factors in decision-making Disparities between rural and metropolitan geographic areas, availability of health services, and time limitations for in-patient decision-making, were described; Condition-related factors in decision-making Clinicians questioned the significance of obesity as part of decision-making due to the practical limitations of dose modification, and the rarity of the extremely obese cohort; Decision-making in the context of uncertainty Clinicians reported limited availability, reliability and awareness of primary evidence including limited guidance from clinical guidelines for DOAC use in obesity.
Conclusion: This study highlights the complexity of decision-making for clinicians, due to the limited availability, reliability and awareness of evidence, the intrinsic complexity of the obese cohort and limited guidance from clinical guidelines. This highlights the urgent need for contemporary research to improve the quality of evidence to guide informed shared decision-making.
(© 2023. The Author(s).)
Databáze: MEDLINE
Externí odkaz: