Practices, beliefs, and attitudes of clinicians in prescribing direct oral anticoagulants for obese adults with atrial fibrillation: a qualitative study.

Shaikh, F; Wynne, R; Castelino, RL; Inglis, SC; Davidson, PM; Ferguson, C

Practices, beliefs, and attitudes of clinicians in prescribing direct oral anticoagulants for obese adults with atrial fibrillation: a qualitative study.

Shaikh, F Wynne, R Castelino, RL Inglis, SC Davidson, PM Ferguson, C

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Publisher:: Springer Nature
Publication Type:: Journal Article
Citation:: Int J Clin Pharm, 2023, 45, (4), pp. 962-969
Issue Date:: 2023-08

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Field	Value	Language
dc.contributor.author	Shaikh, F
dc.contributor.author	Wynne, R
dc.contributor.author	Castelino, RL
dc.contributor.author	Inglis, SC
dc.contributor.author	Davidson, PM
dc.contributor.author	Ferguson, C https://orcid.org/0000-0002-2417-2216
dc.date.accessioned	2023-09-11T01:37:39Z
dc.date.available	2023-03-24
dc.date.available	2023-09-11T01:37:39Z
dc.date.issued	2023-08
dc.identifier.citation	Int J Clin Pharm, 2023, 45, (4), pp. 962-969
dc.identifier.issn	2210-7703
dc.identifier.issn	2210-7711
dc.identifier.uri	http://hdl.handle.net/10453/172023
dc.description.abstract	BACKGROUND: Atrial fibrillation (AF) and obesity affect over 60 and 650 million people, respectively. AIM: This study aimed to explore clinician practices, beliefs, and attitudes towards the use of direct oral anticoagulants (DOACs) in obese adults (BMI ≥ 30 kg/m2) with AF. METHOD: Semi-structured interviews via video conference were conducted with multidisciplinary clinicians from across Australia, with expertise in DOAC use in adults with AF. Clinicians were invited to participate using purposive and snowball sampling techniques. Data were analysed in NVIVO using thematic analysis. RESULTS: Fifteen clinicians including cardiologists (n = 5), hospital and academic pharmacists (n = 5), general practitioners (n = 2), a haematologist, a neurologist and a clinical pharmacologist participated. Interviews were on average 31 ± 9 min. Key themes identified were: Health system factors in decision-making Disparities between rural and metropolitan geographic areas, availability of health services, and time limitations for in-patient decision-making, were described; Condition-related factors in decision-making Clinicians questioned the significance of obesity as part of decision-making due to the practical limitations of dose modification, and the rarity of the extremely obese cohort; Decision-making in the context of uncertainty Clinicians reported limited availability, reliability and awareness of primary evidence including limited guidance from clinical guidelines for DOAC use in obesity. CONCLUSION: This study highlights the complexity of decision-making for clinicians, due to the limited availability, reliability and awareness of evidence, the intrinsic complexity of the obese cohort and limited guidance from clinical guidelines. This highlights the urgent need for contemporary research to improve the quality of evidence to guide informed shared decision-making.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Springer Nature
dc.relation.ispartof	Int J Clin Pharm
dc.relation.isbasedon	10.1007/s11096-023-01583-z
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1115 Pharmacology and Pharmaceutical Sciences, 1199 Other Medical and Health Sciences
dc.subject.classification	Pharmacology & Pharmacy
dc.subject.mesh	Humans
dc.subject.mesh	Adult
dc.subject.mesh	Atrial Fibrillation
dc.subject.mesh	Anticoagulants
dc.subject.mesh	Stroke
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Attitude
dc.subject.mesh	Obesity
dc.subject.mesh	Administration, Oral
dc.subject.mesh	Humans
dc.subject.mesh	Atrial Fibrillation
dc.subject.mesh	Obesity
dc.subject.mesh	Anticoagulants
dc.subject.mesh	Administration, Oral
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Attitude
dc.subject.mesh	Adult
dc.subject.mesh	Stroke
dc.subject.mesh	Humans
dc.subject.mesh	Adult
dc.subject.mesh	Atrial Fibrillation
dc.subject.mesh	Anticoagulants
dc.subject.mesh	Stroke
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Attitude
dc.subject.mesh	Obesity
dc.subject.mesh	Administration, Oral
dc.title	Practices, beliefs, and attitudes of clinicians in prescribing direct oral anticoagulants for obese adults with atrial fibrillation: a qualitative study.
dc.type	Journal Article
utslib.citation.volume	45
utslib.location.activity	Netherlands
utslib.for	1115 Pharmacology and Pharmaceutical Sciences
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	open_access	*
dc.date.updated	2023-09-11T01:37:37Z
pubs.issue	4
pubs.publication-status	Published
pubs.volume	45
utslib.citation.issue	4

Abstract:

BACKGROUND: Atrial fibrillation (AF) and obesity affect over 60 and 650 million people, respectively. AIM: This study aimed to explore clinician practices, beliefs, and attitudes towards the use of direct oral anticoagulants (DOACs) in obese adults (BMI ≥ 30 kg/m2) with AF. METHOD: Semi-structured interviews via video conference were conducted with multidisciplinary clinicians from across Australia, with expertise in DOAC use in adults with AF. Clinicians were invited to participate using purposive and snowball sampling techniques. Data were analysed in NVIVO using thematic analysis. RESULTS: Fifteen clinicians including cardiologists (n = 5), hospital and academic pharmacists (n = 5), general practitioners (n = 2), a haematologist, a neurologist and a clinical pharmacologist participated. Interviews were on average 31 ± 9 min. Key themes identified were: Health system factors in decision-making Disparities between rural and metropolitan geographic areas, availability of health services, and time limitations for in-patient decision-making, were described; Condition-related factors in decision-making Clinicians questioned the significance of obesity as part of decision-making due to the practical limitations of dose modification, and the rarity of the extremely obese cohort; Decision-making in the context of uncertainty Clinicians reported limited availability, reliability and awareness of primary evidence including limited guidance from clinical guidelines for DOAC use in obesity. CONCLUSION: This study highlights the complexity of decision-making for clinicians, due to the limited availability, reliability and awareness of evidence, the intrinsic complexity of the obese cohort and limited guidance from clinical guidelines. This highlights the urgent need for contemporary research to improve the quality of evidence to guide informed shared decision-making.

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http://hdl.handle.net/10453/172023