Periprocedural Antithrombotic Management from a Patient Perspective: A Qualitative Analysis

Abstract

Background-Peri-procedural antithrombotic medication management is a complex, often confusing process for patients and their providers. Communication difficulties often lead to suboptimal medication management resulting in delayed or cancelled procedures. Methods-We conducted telephone surveys with patients taking chronic antithrombotic medications who had recently undergone an endoscopy procedure. In the survey, we sought to better understand the peri-procedural process for patients taking antithrombotic medications. We conducted a content analysis of patients' unstructured responses from the peri-procedural patient phone calls. We used a multi-step group coding process to analyze responses. Relationships between different themes and categories were analyzed using original quotes and retrieving thematic segments from the transcripts.

Improving preprocedure antithrombotic management: Implementation and sustainment of a best practice alert and pharmacist referral process

“…It also leads to last‐minute procedural cancellations as well as patient and clinician dissatisfaction. 11 …”

“…Mismanagement of antithrombotic medications places patients at increased risk of potentially life‐threatening bleeding and/or thromboembolic complications (blood clots). It also leads to last‐minute procedural cancellations as well as patient and clinician dissatisfaction 11 …”

“…It also leads to last-minute procedural cancellations as well as patient and clinician dissatisfaction. 11 We used gastrointestinal (GI) endoscopy procedures as an exemplary case study to test an EMR-based intervention. Specifically, we developed and implemented an automated EMR best practice alert (BPA), or reminder, and referral process to a dedicated anticoagulation clinic for patients taking chronic antithrombotic medications before their elective outpatient GI endoscopy procedures.…”

Assessment of a Best Practice Alert and Referral Process for Preprocedure Antithrombotic Medication Management for Patients Undergoing Gastrointestinal Endoscopic Procedures

“…4 For their part, patients also commonly express confusion and dissatisfaction with the coordination of their medications before elective procedures. 5 Before procedures, antithrombotic medications may be managed by 1 of 3 health care professionals: (1) the original prescriber of the drug (eg, cardiologist); (2) the proceduralist (eg, gastroenterologist); or (3) the referring clinician (eg, primary care clinician). Poorly coordinated preprocedure antithrombotic medication management can lead to inefficient and unsafe care, poor patient satisfaction, and potential delays in care delivery.…”

“…Poorly coordinated preprocedure antithrombotic medication management can lead to inefficient and unsafe care, poor patient satisfaction, and potential delays in care delivery. 5 Although particularly robust anticoagulation clinics may assist with preprocedural anticoagulant management, fewer assist with managing antiplatelet medication before procedures, despite frequent concurrent use of anticoagulant and antiplatelet medications. 6,7 Anticoagulation clinics that provide preprocedure anticoagulant management often do so selectively and without an established referral process.…”