Tompson, Alice, Heneghan, Carl, Sutton, Stephen, Fitzmaurice, David and Ward, Alison (2016) Impact of self-funding on patient experience of oral anticoagulation self-monitoring : a qualitative study. BMJ Open, 6 (12). e013123. doi:10.1136/bmjopen-2016-013123 ISSN 2044-6055.

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Abstract

Objective

To explore the impact self-funding has on patient experience of oral anticoagulation therapy self-monitoring.

Design

Semistructured, qualitative interviews were conducted. Transcripts were analysed thematically using constant comparison.

Setting

England.

Participants

Interviewees were participants of the Cohort Study of Anticoagulation Self-Monitoring (CASM). Cohort members were recruited as they bought a monitor from the major manufacturer in the UK. A purposive
sample was invited to be interviewed on completion of the 12-month cohort follow-up.

Data

Patient narratives on their experiences of self-monitoring their oral anticoagulation therapy in non-trial conditions.

Results

26 interviews were completed. Interviewees viewed purchasing the monitoring device as a long-term commitment balancing the limitations of clinic-based monitoring against the cost. They were unable
to try out the monitor prior to purchase and therefore had to be confident in their own ability to use it. The variable provision of self-monitoring equipment caused resentment, and interviewees were uncomfortable negotiating with healthcare professionals. High test strip usage while learning how to use the monitor caused anxiety that was exacerbated by worries about their cost. However, self-funding did mean that interviewees felt a sense of ownership and were determined to persevere to overcome problems.

Conclusions

Self-funding has negative implications in terms of equity of access; however, the money invested acts as a barrier to discontinuation. If oral anticoagulation therapy self-monitoring devices and consumables were provided free of charge in routine care, the training and support available in England may need to be reviewed to prevent discontinuation rates rising to those observed in clinical trials.

Item Type:	Journal Article
Subjects:	R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Anticoagulants (Medicine) -- Case studies, Thromboembolism, Blood coagulation tests, Patient monitoring, Oral medication -- Case studies, Anticoagulants (Medicine) -- Therapeutic use
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	1 December 2016
Dates:	Date Event 1 December 2016 Published 23 December 2016 Available 7 November 2016 Accepted 27 June 2016 Submitted
Volume:	6
Number:	12
Article Number:	e013123
DOI:	10.1136/bmjopen-2016-013123
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	27 November 2017
Date of first compliant Open Access:	27 November 2017

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