scholarly journals Oral anticoagulants and clinical decision making for stroke prevention in non-valvular atrial fibrillation for nurse practitioners

2014 ◽  
Author(s):  
Raquel Batalha de Queiroz
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Nurse Practitioners ◽  
Stroke Prevention ◽  
Clinical Decision Making ◽  
Oral Anticoagulants ◽  
Clinical Decision

Content and Process in Clinical Decision-Making by Nurse Practitioners

1992 ◽  
Vol 24 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Joyce E. White ◽  
Donna G. Nativio ◽  
Shirley N. Kobert ◽  
Sandra J. Engberg
Keyword(s):  
Decision Making ◽  
Nurse Practitioners ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation – A qualitative study

2020 ◽  
Author(s):  
Vanessa WS Ng ◽  
Chung-Wah Siu ◽  
Patrick KC Chiu ◽  
Carolyn PL Kng ◽  
Elizabeth Jamieson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Treatment Guidelines ◽  
Oral Anticoagulants ◽  
Structured Interview ◽  
Bleeding Complications ◽  
Suitable Alternative ◽  
Prevention Therapy

Abstract Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers.Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

scholarly journals Understanding the Barriers to Using Oral Anticoagulants Among Long-Term Aspirin Users With Atrial Fibrillation – A Qualitative Study

2020 ◽  
Author(s):  
Vanessa WS Ng ◽  
Chung-Wah Siu ◽  
Patrick KC Chiu ◽  
Carolyn PL Kng ◽  
Elizabeth Jamieson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Treatment Guidelines ◽  
Oral Anticoagulants ◽  
Structured Interview ◽  
Bleeding Complications ◽  
Suitable Alternative ◽  
Prevention Therapy

Abstract Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

scholarly journals A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical Decision-Making

2019 ◽  
Vol 29 (1) ◽  
pp. 1-8
Author(s):  
Khadijah E. Abdallah ◽  
Kathleen A. Calzone ◽  
Jean F. Jenkins ◽  
Melissa E. Moss ◽  
Sherrill L. Sellers ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Decision Making ◽  
Genetic Variation ◽  
Nurse Practitioners ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
General Internal

Objective: The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study in­vestigates primary care providers’ use of race in clinical practice.Methods: Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial At­tributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers’ knowledge of human genetic variation.Results: In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians’ score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67).Conclusions: Physicians had more knowl­edge of genetic variation and used patients’ race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further explora­tion of these differences is needed, including examination of physicians’ and NPs’ beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care dispari­ties.Ethn Dis.2019;29(1):1-8; doi:10.18865/ ed.29.1.1.

The Effects of Clinical Decision Making on Nurse Practitioners’ Clinical Productivity

2000 ◽  
Vol 23 (3) ◽  
pp. 284-304 ◽  
Author(s):  
Neale R. Chumbler ◽  
Jack M. Geller ◽  
Andrew W. Weier
Keyword(s):  
Decision Making ◽  
Nurse Practitioners ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Demographic Characteristics ◽  
Policy Implications ◽  
Group Practice ◽  
Full Time ◽  
Specialty Area ◽  
Primary Practice

The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic characteristics, practice attributes, and primary practice settings of NPs impact their level of clinical decision making (e.g., the autonomy to order laboratory and radiological tests or to refer a patient to a physician specialist other than their collaborating physician)? Do NPs’ levels of clinical decision making correlate with their outpatient clinical productivity, adjusting for demographic characteristics, practice attributes, and primary practice settings? The multiple linear regression results indicated that having more years in practice as an NP, practicing in the family specialty area (vs. a combined other category, which included pediatrics, acute care, geriatrics, neonatal, and school), treating patients according to clinical guidelines, practicing in settings with a fewer number of physicians, and practicing in a multispecialty group practice versus a single-specialty group practice were associated with greater levels of clinical decision making. However, NPs who primarily practiced in a hospital/facility-based practice, as compared with a single-specialty group practice, had lower levels of clinical decision making. After adjusting for demographic characteristics, practice attributes, and primary practice settings, NPs with greater clinical decision-making authority had greater outpatient clinical productivity. The conclusions discuss the policy implications of the findings.

scholarly journals Exploring patient–provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: Results of the INFORM-AF study

2018 ◽  
Vol 18 (4) ◽  
pp. 280-288 ◽  
Author(s):  
Sean D Pokorney ◽  
Diane Bloom ◽  
Christopher B Granger ◽  
Kevin L Thomas ◽  
Sana M Al-Khatib ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Decision Aids ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Decisional Conflict ◽  
Increased Risk ◽  
Outpatient Settings ◽  
Depth Interviews

Background: Atrial fibrillation is associated with stroke, yet approximately 50% of patients are not treated with guideline-directed oral anticoagulants (OACs). Aims: Given that the etiology of this gap in care is not well understood, we explored decision-making by patients and physicians regarding OAC use for stroke prevention in atrial fibrillation. Methods and results: We conducted a descriptive qualitative study among providers ( N=28) and their patients with atrial fibrillation for whom OACs were indicated ( N=25). We used purposive sampling across three outpatient settings in which atrial fibrillation patients are commonly managed: primary care ( n=14), geriatrics ( n=10), and cardiology ( n=4). Eligible patients were stratified by those prescribed OAC ( n=13) and not prescribed OAC ( n=12). Semi-structured, in-depth interviews assessed decision-making regarding risk and OAC use. Classical content analysis was used to code narratives and identify themes. Results among patients consisted of the overarching theme of trust in provider recommendations. Sub-themes included: awareness of increased risk of stroke with atrial fibrillation; willingness to accept medications recommended by their physician; and low demand for explanatory decision aids. Among physicians, the overarching theme was decisional conflict regarding the balance between stroke and bleeding risk, and the optimal medication to prescribe. Subthemes included: absence of decision aids for communication; and misperceptions around the assessment and management of stroke risk with atrial fibrillation. Conclusions: Patient involvement in decision-making around OAC use did not occur in this study of patients with atrial fibrillation. Improved access to decision aids may increase patient engagement in the decision-making process of OAC use for stroke prevention.

Frequency Measures Obtained from the Surface Electrocardiogram in Atrial Fibrillation Research and Clinical Decision‐Making

2003 ◽  
Vol 14 (s10) ◽  
pp. S154-S161 ◽  
Author(s):  
ANDREAS BOLLMANN ◽  
DANIELA HUSSER ◽  
MARTIN STRIDH ◽  
LEIF SOERNMO ◽  
MONICA MAJIC ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surface Electrocardiogram
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