Barriers and facilitators to optimal oral anticoagulant management: a scoping review
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Barriers and facilitators to optimal oral anticoagulant management: a scoping review Mei Wang1,2 · Anne Holbrook1,2,3 · Munil Lee4 · Jiayu Liu2 · Alvin Leenus2 · Nora Chen1 · Lawrence Mbuagbaw1,5 · Lehana Thabane1,5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Oral anticoagulants (OACs) are high alert medications and require high-quality management to optimize health outcomes. The objective of this scoping review was to identify barriers and facilitators (B&Fs) associated with the quality of OAC management. We searched MEDLINE, EMBASE, and CINAHL databases until July 12, 2018, and cross-referenced the bibliographies of the retrieved studies. We included quantitative and qualitative studies that assessed B&Fs to OAC management. The study selection and data extraction processes were performed in duplicate. Analyses included measuring the prevalence of reported B&Fs from studies reporting quantitative data, identifying B&Fs in narrative analyses, and identifying their impact on important outcomes of OAC management. B&Fs were coded and aggregated to higher-level themes using a consensus approach. Factors were described as “key” if they were statistically associated with important outcomes in a randomized trial or observational study. We included 62 studies—three randomized clinical trials (RCTs), 46 observational studies (cross-sectional studies, cohort studies, and case–control studies), 11 qualitative studies, and two mixed-methods studies. Factors identified could be grouped into four themes—therapy-related, patient-related, healthcare provider-related, and health system-related. Key barriers to optimal OAC management were mostly patient-related, whereas interventions focused on education or implementing protocols were shown through RCTs to be effective at improving knowledge scores of OAC patients. While multiple barriers and some facilitators were identified in this review, none was proven to be associated with clinical outcomes. With this in mind, individual physicians may wish to address the key barriers in their practice as a quality improvement initiative but system-wide or policy changes should await high-quality evidence. Future trials should address these factors. Systematic review registration: PROSPERO CRD42017069043 Keywords Anticoagulants · Barriers · Facilitators · Medication management · Adherence · Scoping review
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02056-0) contains supplementary material, which is available to authorized users. * Mei Wang [email protected] 1
Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
Clinical Pharmacology & Toxicology, Research Institute, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
2
Oral anticoagulants (OACs) are indicated for the treatment and prevention of thromboembolic events, for atrial fibrillation, ven
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