Article Text

Download PDFPDF

Impact of self-funding on patient experience of oral anticoagulation self-monitoring: a qualitative study
  1. Alice Tompson1,
  2. Carl Heneghan1,
  3. Stephen Sutton2,
  4. David Fitzmaurice3,
  5. Alison Ward1
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2Institute of Public Health, University of Cambridge, Cambridge, UK
  3. 3Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to A Tompson; alice.tompson{at}


Objective To explore the impact self-funding has on patient experience of oral anticoagulation therapy self-monitoring.

Design Semistructured, qualitative interviews were conducted. Transcripts were analysed thematically using constant comparison.

Setting England.

Participants Interviewees were participants of the Cohort Study of Anticoagulation Self-Monitoring (CASM). Cohort members were recruited as they bought a monitor from the major manufacturer in the UK. A purposive sample was invited to be interviewed on completion of the 12-month cohort follow-up.

Data Patient narratives on their experiences of self-monitoring their oral anticoagulation therapy in non-trial conditions.

Results 26 interviews were completed. Interviewees viewed purchasing the monitoring device as a long-term commitment balancing the limitations of clinic-based monitoring against the cost. They were unable to try out the monitor prior to purchase and therefore had to be confident in their own ability to use it. The variable provision of self-monitoring equipment caused resentment, and interviewees were uncomfortable negotiating with healthcare professionals. High test strip usage while learning how to use the monitor caused anxiety that was exacerbated by worries about their cost. However, self-funding did mean that interviewees felt a sense of ownership and were determined to persevere to overcome problems.

Conclusions Self-funding has negative implications in terms of equity of access; however, the money invested acts as a barrier to discontinuation. If oral anticoagulation therapy self-monitoring devices and consumables were provided free of charge in routine care, the training and support available in England may need to be reviewed to prevent discontinuation rates rising to those observed in clinical trials.

  • self-monitoring
  • self-funding

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from


  • Contributors AW and CH conceptualised the study. AW, CH, DF and SS participated in the protocol design. AT conducted the interviews, analysed the results and drafted the manuscript. All authors read and approved the final manuscript.

  • Funding The study was supported by the National Institute for Health Research (NIHR) Research for Patient Benefit grant (PB-PG-0408-15191) and from the NIHR National School for Primary Care Research.

  • Disclaimer This report presents independent research commissioned by the NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funding body had no role in study design; collection, analysis or interpretation of data; writing the manuscript; or the decision to submit.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by Berkshire Research Ethics Committee (08/H0505/142).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Declaration of transparency The lead author affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.