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Impact of self-funding on patient experience of oral anticoagulation self-monitoring : a qualitative study
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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
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WRAP-impact-self-funding-patient-experience-oral-anticoagulation-self-monitoring-Fitzmaurice-2017.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1117Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/bmjopen-2016-013123
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 Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| 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: |
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| Date of first compliant deposit: | 27 November 2017 | ||||||||||
| 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 |
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