Patient And Physician Practices With Oral Anticoagulants
Douglas L. Wooster, MD.
Univ of Toronto, Toronto, ON, Canada.
Objectives: Vascular specialists (VS) see patients receiving oral anticoagulants (OAC) prescribed for venous, arterial, cardiac and other indications. Although these medications may be ordered and monitored by other physicians, VS must be aware of OAC guidelines, indications, usage, complications and impact on procedures to provide proper care. There may be a knowledge and practice gap with respect to OAC use. The aims of this study were to assess behaviors, identify care gaps and consider educational interactions related to OAC management.
Methods: Consecutive patients seen in clinic were tracked for OAC use and related practices to guidelines and complications. Patients (P), primary care providers (PCP) and specialists (S) were interviewed using standardized questionnaires to assess knowledge and practices with respect to OAC. Patients were assessed regarding knowledge of side effects and instructions for use; PCP and S were assessed regarding knowledge of guidelines, product side effects, dosing and use of OAC. Educational strategies they had used with respect to OAC use were assayed. The findings were tabulated and analyzed to identify gaps and consider educational interventions.
Results: 122 patients were identified to be on OAC; 20 PCP and 5 S in each of cardiology, hematology, emergency medicine and respirology were interviewed. Specific indications for OAC treatment included arrhythmia (22), PAD (8), SVT (42), DVT (30) and other (20). The OAC used included Warfarin (20), Rivaroxaban (62), Apixaban (30), Dibigatran (6) and other (4). Appropriateness of OAC was consistent with guidelines in 110 (90%); dosing was appropriate in 93 (76%) with incorrect frequency (15%), dosage (75%) and adjustment for weight (10%). Bleeding potential was identified by 40% of patients and 90% of physicians. Awareness of contraindications was found in 12% of patients and 65% of physicians with a history of previous bleeding, seizures and renal dysfunction noted. This analysis identified both knowledge and practice gaps. Appropriate educational interventions included company detailing, rounds, conferences, reading and discussion with colleagues or pharmacists; PCP preferred direct advice from S.
Conclusions: There are knowledge and practice gaps amongst patients and physicians with respect to OAC; these can lead to sub-optimal patient care. VS should be prepared to identify gaps and communicate with patients and colleagues. Targeted educational interventions are suggested and should be reinforced on a regular basis.
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