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Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review

Gebreyohannes, EA, Mill, D, Salter, S, Chalmers, L, Bereznicki, L ORCID: 0000-0003-3974-3437 and Lee, K 2021 , 'Strategies for improving guideline adherence of anticoagulants for patients with atrial fibrillation in primary healthcare: A systematic review' , Thrombosis Research, vol. 205 , pp. 128-136 , doi: 10.1016/j.thromres.2021.07.014.

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Abstract

Background:Clinical guidelines on atrial fibrillation management help optimize the use of oral anticoagulants. However, guideline non-adherence is common, particularly in the primary care setting. The primary aim of this systematic review was to identify effective strategies for improving adherence to guideline-directed thromboprophylaxis to patients with atrial fibrillation in the primary care setting.Methods:A search was conducted on 6 electronic databases (Medline, Embase, ScienceDirect, Scopus, the Cumulative Indexing of Nursing and Allied Health Literature, and Web of Science) supplemented by a Google advanced search. Studies aimed at improving oral thromboprophylaxis guideline adherence in patients with atrial fibrillation, in the primary care setting, were included in the study.Results:A total of 33 studies were included in this review. Nine studies employed electronic decision support (EDS), of which 4 reported modest improvements in guideline adherence. Five of 6 studies that utilized local guidelines as quality improvement measures reported improvement in guideline adherence. All 5 studies that employed coordinated care and the use of specialist support and 4 of the 5 studies that involved pharmacist-led interventions reported improvements in guideline adherence. Interventions based mainly on feedback from audits were less effective.Conclusions:Multifaceted interventions, especially those incorporating coordinated care and specialist support, pharmacists, or local adaptations to and implementation of national and/or international guidelines appear to be more consistently effective in improving guideline adherence in the primary care setting than interventions based mainly on EDS and feedback from audits.

Item Type: Article
Authors/Creators:Gebreyohannes, EA and Mill, D and Salter, S and Chalmers, L and Bereznicki, L and Lee, K
Keywords: atrial fibrillation, guideline, adherence, atrial fibrillation, anticoagulants, quality improvement, interventions, primary health care
Journal or Publication Title: Thrombosis Research
Publisher: Pergamon-Elsevier Science Ltd
ISSN: 0049-3848
DOI / ID Number: 10.1016/j.thromres.2021.07.014
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© 2021 Elsevier Ltd. All rights reserved.

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