A qualitative study evaluating provider perceptions of implementing warfarin patient self-management in the United States healthcare system

BackgroundDespite consensus guideline recommendations, the use of warfarin patient self-management (PSM) in the US healthcare system remains small in comparison to European countries.ObjectivesTo gain understanding of the barriers and facilitators to warfarin PSM in US healthcare systems through exploration of the opinions of select US anticoagulation management service providers.MethodsFocus group discussions were conducted at five geographically diverse sites. Grounded theory analysis was performed on focus group transcriptions using the consolidated framework for implementation research (CFIR) to identify facilitators and barriers to PSM implementation within the US healthcare system.ResultsA total of 29 providers participated in eight focus group sessions. Five major themes emerged from the interviews: (1) "Ideal" PSM candidates possess identifiable characteristics (CFIR domain "Characteristics of Individuals"); (2) Providers harbor fears and lack familiarity with PSM facts and principles (CFIR domains "Characteristics of Individuals"; "Inner Setting"; and "Outer Setting"); (3) Providers mistrust patients' capability to engage in PSM (CFIR domains "Characteristics of Individuals"; "Inner Setting"; "Outer Setting"; and "Process"); (4) Despite acknowledging PSM advantages many providers cite workflow issues as barriers to implementation (CFIR domains "Intervention Characteristics"; "Inner Setting"; "Outer Setting"; and "Process"); and (5) Providers differed on how to best train patients to do PSM (CFIR domains "Intervention Characteristics"; and "Inner Setting").ConclusionsProvider concern for patient safety contributes to hesitancy to relinquish control and mistrust of patients' ability to participate in PSM. Education and implementation strategies will be key to overcoming barriers to PSM in the United States.