Use of direct oral anticoagulants in primary care: a qualitative study integrating patient and practitioner perspectives

Background: Older patients with atrial fibrillation (AF) are increasingly offered direct oral anticoagulants (DOACs) to reduce the risk of catastrophic stroke, but clinical follow- up and compliance checks are still required to maintain patient safety. Although a recent qualitative meta- analysis has explored up- to- date research in this area, little is known qualitatively about clinicians' or patients' views and experiences of DOAC use in primary care in the UK.Aim: To understand the experiences of healthcare practitioners and patients in relation to DOAC use in UK primary care.Design & setting: Semi- structured interviews were undertaken. Sixteen older patients with AF taking DOACs, 10 pharmacists, and six GPs were interviewed in Sheffield, England in 2018.Method: Interview questions were developed following a systematic literature review. Interviews were audio- recorded, transcribed, and analysed using six- stage thematic analysis.Results: The integrated perspectives show that all three participant groups preferred DOACs over warfarin, a preference driven mainly by the safety profile compared with warfarin. GPs valued pharmacists' input in anticoagulant care, and pharmacists discussed patient safety in the context of anticoagulant audits, and highlighted the need for continuous patient education and counselling. Medication reviews by pharmacists were seen as a positive contribution to medicines optimisation. Conclusion: Patients had an overriding trust in their doctors. GPs valued a collaborative approach with other clinicians, and community pharmacists appeared to highlight operational challenges in primary care that may limit the effectiveness of interventions.