Improving anticoagulation in atrial fibrillation: observational study in three primary care trusts

Abstract

BackgroundAtrial fibrillation (AF) is a cause of stroke, and undertreatment with anticoagulants is a persistent issue despite their effectiveness. AimTo increase the proportion of people with AF treated appropriately using anticoagulants, and reduce inappropriate antiplatelet therapy. Design of studyCross-sectional analysis. SettingElectronic patient health records on 4604 patients with AF obtained from general practices in three inner London primary care trusts between April 2011 and 2013. MethodThe Anticoagulant Programme East London (APEL) sought to achieve its aims through an intervention with three components: altering professional beliefs using new clinical guidance and related education; facilitating change using computer software to support clinical decisions and patient review optimising anticoagulation; motivating change through evaluative feedback showing individual practice performance relative to peers. ResultsFrom April 2011 to April 2013, the proportion of people with CHA 2 DS 2 -VASc ≥1 on anticoagulants increased from 52.6% to 59.8% (trend difference P<0.001). The proportion of people with CHA 2 DS 2 -VASc ≥1 on aspirin declined from 37.7% to 30.3% (trend difference P<0.001). Comparing the 2 years before the intervention with the 2 years after, numbers of new people on the AF register almost doubled from 108 to 204. ConclusionsThe APEL programme supports improvement in clinical managing AF by a combined programme of education around agreed guidance, computer aids to facilitate decisionmaking and patient review and feedback of locally identifiable results. If replicated nationally over 3 years, such a programme could result in approximately 1600 fewer strokes every year.

NHS Health Check comorbidity and management: an observational matched study in primary care

“…In Tower Hamlets, managed practice networks, including financial incentives, may also have contributed to high performance. 34,40,41 Comparison with existing literature The coverage of 85% found in this study compares with around 50% nationally. Highest coverage and treatment were associated with invites initially targeting those at highest risk and managed practice networks.…”

Optimizing the use of oral anticoagulant therapy for atrial fibrilation in primary care: a pharmacist-led intervention

“…There is, however, a paucity of published literature describing approaches that have been adopted to address this shortfall. The Anticoagulant Programme East London, United Kingdom (UK) (APEL) was an improvement program conducted in three Clinical Commissioning Groups (CCGs, bodies which serve a specific geographical location with responsibility for commissioning healthcare services) [24]. Education, dedicated software and support were provided to medical practices to implement change, resulting in an increase in the proportion of patients being anticoagulated.…”

The Utilization of Antithrombotic Therapy in Older Australians With Atrial Fibrillation

“…The interventions included audit feedback after access to locally produced guidelines, introduction of evidence-based guidelines, and computer software to support clinical decision-making. [28][29][30][31] The selection of a single set of guidelines to be adopted has been shown in Scotland and in a small Australian study to improve treatment rates; this may be effective on a large scale 28,29 and may aid the situation in Australia mainly because local guidelines are also lacking.…”