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Periprocedural Antithrombotic Management from a Patient Perspective: A Qualitative Analysis - 30/03/19

Doi : 10.1016/j.amjmed.2018.11.020 
Jennifer Acosta, MPH a, Christopher Graves, BA b, Elizabeth Spranger, BA c, Jacob Kurlander, MD, MSc d, e, Anne E. Sales, PhD, RN f, Geoffrey D. Barnes, MD, MSc a, b,
a Center for Bioethics and Social Science in Medicine 
b Frankel Cardiovascular Center 
c Performance Improvement, Department of Internal Medicine 
d Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor 
e Veterans Affairs Ann Arbor Health Care System, Mich 
f Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor 

Requests for reprints should be addressed to Geoffrey D. Barnes, MD, MSc, Center for Bioethics and Social Science in Medicine, University of Michigan, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI 48109-2800.Center for Bioethics and Social Science in MedicineUniversity of Michigan2800 Plymouth Rd, B14 G214Ann ArborMI48109-2800

Abstract

Background

Periprocedural antithrombotic medication management is a complex, often confusing process for patients and their providers. Communication difficulties often lead to suboptimal medication management, resulting in delayed or canceled procedures.

Methods

We conducted telephone surveys with patients taking chronic antithrombotic medications who had recently undergone an endoscopy procedure. In the survey, we sought to better understand the periprocedural process for patients taking antithrombotic medications. We conducted a content analysis of patients’ unstructured responses from the periprocedural patient phone calls. We used a multistep group coding process to analyze responses. Relationships between different themes and categories were analyzed using original quotes and retrieving thematic segments from the transcripts.

Results

The survey was administered to 81 patients; 74/81 respondents (91%) said they understood the plan to manage their antithrombotics, but 21/81 respondents (26%) were not completely satisfied with the coordination, communication, and management of their medications. Five primary themes emerged from the content analysis as patient-centered design features affecting periprocedural care: (1) patients require accurate and timely information; (2) a patient's prior experience with antithrombotic therapy affects their understanding of the process; (3) patients prefer receiving their information from a single source, and (4) also prefer different methods of instruction; (5) finally, patients expect their clinician(s) to be available through the periprocedural management process.

Conclusion

To optimize the periprocedural medication management communication process, patients desire timeliness, accuracy, and adaptiveness to prior patient experience while offering a single, consistently available point of contact.

El texto completo de este artículo está disponible en PDF.

Keywords : Anticoagulation, Antithrombotics, Patient–provider communication, Perioperative


Esquema


 Funding: National Institutes of Health/National Heart, Lung, and Blood Institute (K01HL135392 to GDB). The funding organizations had no role in the design and conduct of the study; data collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication.
 Conflict of Interest: GDB – consulting for Pfizer/Bristol Myers Squibb, Janssen, and Portola. Grant support from Pfizer/Bristol Myers Squib, Blue Cross/Blue Shield of Michigan, and the National Heart, Lung, and Blood Institute. The other authors have no disclosures to report.
 Authorship: All authors contributed meaningfully to this manuscript. JA, AS, and GDB conceived of the project idea; JA, CG, and GDB collected and analyzed the data; JA prepared the first draft; CG, ES, JK, AS, and GDB provided substantial edits to the manuscript.


© 2018  Elsevier Inc. Reservados todos los derechos.
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Vol 132 - N° 4

P. 525-529 - avril 2019 Regresar al número
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