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Utilizing Theoretical Domains Framework to Determine Barriers to Evidence-Based Recommendations in Non-Valvular

Evan White1, Sandra L Kane-Gill1, Sandeep Jain2

  • 1School of Pharmacy, Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA.

The Annals of Pharmacotherapy
|November 27, 2024
PubMed

Insights

Clinician adherence to atrial fibrillation (AF) guidelines for anticoagulation is low due to knowledge gaps, cost, patient refusal, and social factors. Interventions can address these barriers to improve care.

Area of Science:

  • Implementation science
  • Behavioral science
  • Clinical practice guidelines

Background:

  • Evidence-based guideline implementation in patient care faces significant inefficiencies, with only 14% of new research routinely adopted.
  • Atrial fibrillation (AF) guidelines recommend anticoagulation based on CHA 2 DS 2 -VASc scores, yet prescribing rates remain low at 51%.
  • Existing frameworks like the Theoretical Domain Framework (TDF) are utilized to identify behavioral changes needed for guideline adoption.

Purpose of the Study:

  • To explore behavioral themes and barriers hindering clinician adherence to evidence-based recommendations for non-valvular atrial fibrillation (NVAF).
  • To develop targeted interventions to overcome identified barriers and improve appropriate anticoagulation prescribing in NVAF patients.

Main Methods:

  • Conducted nine focused interviews with multidisciplinary stakeholders involved in NVAF care.
  • Utilized TDF-based interview questions to identify necessary behavior changes for increasing anticoagulation and decreasing hospital admissions.
  • Transcribed and coded interviews using NVivo 12 software to identify themes and develop interventions.

Main Results:

  • Identified four main barrier themes within the 'knowledge' and 'environmental context and resources' domains of the TDF.
  • Key barriers included lack of knowledge, cost of anticoagulation, patient refusal, and social determinants of health.
  • These barriers impact appropriate NVAF management and anticoagulation prescribing.

Conclusions:

  • The TDF framework effectively identified potential barriers contributing to the underutilization of anticoagulation in NVAF patients.
  • Behavior change intervention techniques can be applied to address these identified barriers.
  • Addressing these barriers is crucial for improving guideline adherence and patient outcomes in NVAF.
Abstract

Keywords:
anticoagulationatrial fibrillationbarriersimplementation science

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