PB0503 - Patient Perspectives on Barriers and Facilitators to Warfarin Patient Self-Management in the US Healthcare System

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

Aaron S. Wilson, PharmD

Clinical Anticoagulation Fellow
University of Utah College of Pharmacy
Salt Lake City, Utah, United States
AJ

Aubrey E. Jones

Research Assistant Professor
University of Utah College of Pharmacy
Salt Lake City, Utah, United States
SS

Stacey Slager

Compliance Officer
University of Utah
Salt Lake City, Utah, United States
Sara Vazquez, PharmD

Clinical Pharmacist
University of Utah Health
Salt Lake City
RF

Ryan Fleming

Manager
University of Utah Thrombosis Service
Salt Lake City, Utah, United States
GB

Geoffrey Barnes

Cardiologist
University of Michigan
Ann Arbor, Michigan, United States
Katelyn W. Sylvester, PharmD, BCPS, CACP

Pharmacy Manager
Brigham and Women's Hospital
Boston, Massachusetts, United States
LC

Linh Chan

Anticoagulation Service
VA Loma Linda Healthcare System
Loma Linda, California, United States
BR

Bishoy Ragheb

Anticoagulation Service
VA Eastern Colorado Health Care System
Aurora, Colorado, United States

Presenting Author(s)

Daniel M. Witt, PharmD

Professor and Chair
University of Utah College of Pharmacy
Salt Lake City, Utah, United States

Background: Warfarin patient self-management (PSM) is associated with clinical outcomes that overwhelming favor PSM over clinician-based care. Unfortunately, PSM is virtually nonexistent in the United States (US).

Aims: This study aimed to identify potential barriers and facilitators to PSM implementation from the perspective of US patients receiving warfarin.

Methods: Qualitative interviews of US anticoagulated patients were conducted using a semi-structured template. Qualitative analysis was performed to identify relevant barriers and facilitators to warfarin PSM implementation.

Results: A total of 42 patients from five healthcare organizations were interviewed. Key barriers included lack of knowledge of PSM as a management option, lack of access to home INR monitors, feeling disconnected from anticoagulation providers, lack of confidence in clinical decision-making abilities, need for weekly INR testing, and cognitive ability. Key facilitators included desire for more engagement in one’s healthcare, access to home INR monitors, trusting relationships with anticoagulation providers, self confidence in decision-making, awareness of one’s own healthcare needs, and good social support networks. Several factors were identified that depending on the context could be considered either a facilitator/advantage or a barrier/drawback of PSM. Most patients felt that the support of their anticoagulation provider would be very important to successfully implementing PSM.

Conclusion(s): Patient perspectives on barriers and facilitators to PSM implementation in the US healthcare system were identified through qualitative interviews. This information will be used to develop an implementation toolkit aimed at supporting PSM implementation in the US healthcare system.