Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review

Eyob Alemayehu Gebreyohannes; Deanna Mill; Sandra Salter; Leanne Chalmers; Luke Bereznicki; Kenneth Lee

doi:10.1016/j.thromres.2021.07.014

Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review

Eyob Alemayehu Gebreyohannes^* (Corresponding Author), Deanna Mill, Sandra Salter, Leanne Chalmers, Luke Bereznicki, Kenneth Lee

^*Corresponding author for this work

Applied Health Sciences

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

BACKGROUND: Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting.

METHODS: A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study.

RESULTS: A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective.

CONCLUSIONS: Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.

Original language	English
Pages (from-to)	128-136
Number of pages	8
Journal	Thrombosis Research
Volume	205
Early online date	29 Jul 2021
DOIs	https://doi.org/10.1016/j.thromres.2021.07.014
Publication status	Published - 1 Sept 2021
Event	12th PCNE Working Conference : Partnering for better patient outcomes- challenges and opportunities - Online Duration: 3 Feb 2021 → 6 Feb 2021 https://www.pcne.org/conference/28/12th-pcne-working-conference-2021

Bibliographical note

Acknowledgements
We would like to acknowledge Mrs. Terena Solomons (librarian, Faculty of Sciences, UWA) for providing consultations to conduct a systematic search of the scientific literature. Mr. Eyob Alemayehu Gebreyohannes is a Ph.D. student and a recipient of the University of Western Australia International Fee Scholarship and University Postgraduate Award. Mr. Gebreyohannes would like to acknowledge the University of Western Australia for supporting his studies. Miss Deanna Mill is supported by an Australian Government Research Training Program (RTP) Scholarship at the University of Western Australia. Also, the abstract of this manuscript was presented online at the 12th PCNE (Pharmaceutical Care Network Europe) Working Conference 2021, Partnering for better patient outcomes-challenges and opportunities. The conference was held 3-6 February 2021.

Data Availability Statement

All data generated or analyzed during this study are included in this published article.

Supplementary data to this article can be found online at https://doi. org/10.1016/j.thromres.2021.07.014.

Keywords

atrial fibrillation
anticoagulant
quality improvement tools
interventions
primary health care

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Cite this

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title = "Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review",

abstract = "BACKGROUND: Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting.METHODS: A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study.RESULTS: A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective.CONCLUSIONS: Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.",

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note = "Acknowledgements We would like to acknowledge Mrs. Terena Solomons (librarian, Faculty of Sciences, UWA) for providing consultations to conduct a systematic search of the scientific literature. Mr. Eyob Alemayehu Gebreyohannes is a Ph.D. student and a recipient of the University of Western Australia International Fee Scholarship and University Postgraduate Award. Mr. Gebreyohannes would like to acknowledge the University of Western Australia for supporting his studies. Miss Deanna Mill is supported by an Australian Government Research Training Program (RTP) Scholarship at the University of Western Australia. Also, the abstract of this manuscript was presented online at the 12th PCNE (Pharmaceutical Care Network Europe) Working Conference 2021, Partnering for better patient outcomes-challenges and opportunities. The conference was held 3-6 February 2021.; 12th PCNE Working Conference : Partnering for better patient outcomes- challenges and opportunities ; Conference date: 03-02-2021 Through 06-02-2021",

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T1 - Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare

T2 - 12th PCNE Working Conference

AU - Gebreyohannes, Eyob Alemayehu

AU - Mill, Deanna

AU - Salter, Sandra

AU - Chalmers, Leanne

AU - Bereznicki, Luke

AU - Lee, Kenneth

N1 - Acknowledgements We would like to acknowledge Mrs. Terena Solomons (librarian, Faculty of Sciences, UWA) for providing consultations to conduct a systematic search of the scientific literature. Mr. Eyob Alemayehu Gebreyohannes is a Ph.D. student and a recipient of the University of Western Australia International Fee Scholarship and University Postgraduate Award. Mr. Gebreyohannes would like to acknowledge the University of Western Australia for supporting his studies. Miss Deanna Mill is supported by an Australian Government Research Training Program (RTP) Scholarship at the University of Western Australia. Also, the abstract of this manuscript was presented online at the 12th PCNE (Pharmaceutical Care Network Europe) Working Conference 2021, Partnering for better patient outcomes-challenges and opportunities. The conference was held 3-6 February 2021.

PY - 2021/9/1

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N2 - BACKGROUND: Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting.METHODS: A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study.RESULTS: A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective.CONCLUSIONS: Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.

AB - BACKGROUND: Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting.METHODS: A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study.RESULTS: A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective.CONCLUSIONS: Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.

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KW - anticoagulant

KW - quality improvement tools

KW - interventions

KW - primary health care

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SP - 128

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JO - Thrombosis Research

JF - Thrombosis Research

Y2 - 3 February 2021 through 6 February 2021

ER -

Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

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