EFPC_20100923- cb

Cooperation in oral anticoagulant therapy : 

Cooperation in oral anticoagulant therapy needs and barriers to improve H. Drewes, M. Lambooij, C. Baan, B. Meijboom, G. Westert

Oral anticoagulant therapy (OAT) : 

Oral anticoagulant therapy (OAT) OAT reduce the risk of thrombosis Challenge: balance the risk between haemoraghe and thrombosis Balance influenced by many factors e.g. co-medication, fever, food intake, doses advices Balance influenced by many health care professionals  Cooperation needed No. of patients in NL: 350.000 25% of avoidable hospitalizations related to OAT

Anticoagulant clinics (AC) : 

Anticoagulant clinics (AC) In Netherlands 59 anticoagulant clinics (ACs): monitoring patients and advice on medication use ACs provide better patient outcomes than routine medical care However: Substantial differences in patient outcomes between ACs Differences in cooperation between ACs e.g. multidisciplinary protocols, structural meetings etc.

Research questions : 

Research questions To identify the bottlenecks for cooperation To identify facilitators/solutions to improve cooperation To identify barriers for improvement the cooperation

Methods : 

Methods Data 23 specialised anticoagulant clinics (AC) selective purposive sampling based on 3 characteristics: the number of patients the organisation structure quality of care considering the patient outcomes 68 semi-structured interviews

Methods : 

Methods Data analysis Fully transcriped interviews open coded by two authors data structured with Chronic Care Model

Experienced bottlenecks : 

Experienced bottlenecks Lack of knowledge: Although a patient was stable with 6 tablets a day, he was discharged with a doses of 4, 2, 2, for the following three days. [..]You could say, ask the patient what he usually used. Lack of consensus between professionals We don’t agree with the policy of one of our hospitals, but couldn’t convince them. We have to follow their advice; otherwise patients are send home without an operation. Limited information exchange Really, it is sometime a struggle to get the information about a hospital admission.

Experienced bottlenecks : 

Experienced bottlenecks Bottlenecks leads to: - Suboptimal OAT - Inefficacy due to time-consuming effort to correct mistakes

Preferred initiatives : 

Preferred initiatives

Major Experienced barriers : 

Major Experienced barriers Lack of motivation professionals not motivated to learn from ACs (no knowledge) don’t accept their view (no consensus) are not motivated to inform the ACs (no information). Lack of time Lack of resources/ materials

Conclusions : 

Conclusions Bottlenecks of coordination are information exchange, lack of knowledge, lack of consensus Decision support is prerequisite for the succes of AC management as it improves knowledge Crucial to succesfully implement decision support seems to be informal coordination/contact