Table 3

Potential barriers

ThemeSubthemeReflectionExemplary quote
Potential barriersAnticoagulant issuesDifferences between long-term versus short-term drug costs need to be highlighted.‘There are differences between monitoring DOAC and warfarin… Costs get lost in a larger scheme.’
There is a need to highlight the reduced adverse effects for patients through the use of alternative drugs.‘It has a big impact on your life… I would like if we would no longer need to use Warfarin. It’s rat poison… Warfarin is horrible. There are so many side effects in every part of life—if I need to go to the dentist, it creates the need for more antibiotics. I hate antibiotics and I only take what I have to. It (brings) cold to parts of the body you don’t even know you have. I know that it keeps me alive but anything other than warfarin is a blessing.’
Most patients and clinicians are willing to switch once they are made aware of alternatives.‘I’d switch in the morning and I’ve been taking [warfarin] for 14 years. I won’t not take it but if there was an alternative I would switch.’
Effective treatmentResource scarcity constitutes a key barrier to effective treatment.‘Doctors and nurses are critically short [in number].’
While technology can empower patients, it may also create resource pressures for clinicians.‘The resources haven’t caught up with the technology. I’m sent multiple things, and also patients phone to say they’re coming in. But still there is a list I have to process.’
Patients do not always adhere to medication prescriptions, which creates clinician distrust.‘There is a “life is busy/tablets are busy” conflict. However, many patients don’t realise that the tablet is preventing stroke.’
Switching to NOACsUncertainty around guidelines is an issue when switching to NOACs.‘Guidelines and recommendations are needed on how many times you should bring patients back. The pharmacist goes to the GP if something is wrong.’
There is a need for patient education in order to improve patient–clinician communication.‘Patient education and empowerment are crucial. Patients that are on the drug for years think they know, but research does not back this up. We need to make every contact count. There needs to be one message. [This allows patients to] come along on the journey, through a collaborative approach.’
  • DOAC, direct oral anticoagulant; GP, general practitioner; NOAC, new oral anticoagulant.