Hijazeen, Rima (2018) Implementation and evaluation of a computerised anticoagulation decision support tool for managing atrial fibrillation. Doctoral thesis, Keele University.

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Abstract

Background: Anticoagulation therapy for patients with atrial fibrillation (AF) remains a national challenge. A decision support tool (DST) was developed to assist healthcare professionals (HCPs) in the appropriate prescribing of anticoagulants in patients with AF. This thesis aimed to evaluate the utility of the DST and associated patient decision aid (PDA) for anticoagulant decision making in clinical practice.

Methods: This study involved a series of sequential stages in the evaluation of the DST. Semi-structured interviews were conducted with forty-seven HCPs to explore their perceptions of anticoagulation prescribing decision. Using a vignette, the perspective of HCPs on the potential utility of the DST and associated PDA were explored using both semi-structured interviews and questionnaires. Second interviews were conducted approximately eight weeks from the initial contact to explore HCPs’ perspectives on the actual utility from implementing the DST and associated PDA in routine clinical practice. The perspectives of a group of AF patients’ who had experienced the DA during consultation were explored using semi-structured interviews and questionnaires.

Results: Qualitative themes elicited during initial contact revealed that anticoagulants prescribing decision can be suboptimal. Findings from the pre-intervention evaluation showed that the DST has potential to improve the quality of anticoagulants decision process. Findings from post-intervention evaluation demonstrated improvements in anticoagulants decision-making in clinical practice. Findings from fourteen patients revealed that the DA was effective in facilitating a quality decision that was informed and consistent with personal values and expectations.

Conclusions: This study demonstrated the positive impact the DST can have on the quality of anticoagulants decision-making in clinical practice and provides a unique contribution to the existing CDSS research. The ever-increasing demand for a quality decision-making process in clinical practice is a fertile environment for clinicians and policymakers to consider the potential impact that the DST and associated PDA can offer.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RS Pharmacy and materia medica
Divisions: Faculty of Medicine and Health Sciences > School of Pharmacy
Depositing User: Lisa Bailey
Date Deposited: 30 Jul 2018 09:13
Last Modified: 30 Jul 2018 09:13
URI: http://eprints.keele.ac.uk/id/eprint/5169

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