Thumbnail Image
Publication

Barriers and enablers to the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation. A qualitative study with patients and staff in three health economies

Publication Date
2021
End of Embargo
Supervisor
Petty, Duncan R.
Stirling, K.
Richardson, Sue
Fylan, Beth
Rattray, Marcus
Keywords
New medicines, Direct oral anticoagulants (DOAC), Anticoagulants, Uptake, Implementation, Stroke, Atrial fibrillation, Diffusion of innovation, Shared decision making, Health economies
Rights
Creative Commons License
The University of Bradford theses are licenced under a Creative Commons Licence.
Peer-Reviewed
Open Access status
Accepted for publication
Institution
University of Bradford
Department
School of Pharmacy and Medical Sciences, Faculty of Life Sciences
Awarded
2021
Embargo end date
Collections
Theses
Show all metadata
Files
Thumbnail Image
PhD Thesis
Adobe PDF, 7.52 MB
Additional title
Abstract
Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the relative uptake of new medicines recommended by the National Institute for Health and Care Excellence often lags behind other comparative countries’ health systems. One example is the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation, which was slow and had a high level of unexplained variation across different health economies in England. This research aimed to explore barriers and enablers to the uptake of DOACs from the perspectives of patients, healthcare professionals, and key stakeholders by conducting systematic and narrative reviews and semi-structured interviews. Data collected from 21 patients, 23 healthcare professionals, and 23 key stakeholders recruited from three different health economies was analysed using the Framework method. The findings identified a range of intersecting factors acting as barriers and/or enablers to the uptake DOACs. While there were a wide range of experiences and views, an agreement between patients and healthcare professionals/key stakeholders on several identified factors was observed. Attributes of the innovation, characteristics of patients and prescribers, local health economy readiness for change, implementation process, and external health system context were suggested as influences. Mapping of the findings to the Diffusion of Innovations in Service Organisations model identified 11 components for a future toolkit development to facilitate uptake of nationally recommended new medicines. This thesis highlighted the role of patients, consideration of all costs associated with new medicines, and compatibility with the health economy’s care model impact on the uptake.
URI
http://hdl.handle.net/10454/18976
Version
Citation
Link to publisher’s version
Link to published version
Link to Version of Record
Type
Thesis
Qualification name
PhD
Notes