A qualitative study of warfarin self-management in the United States healthcare system: insights from patient experiences.

Abstract

Evidence-based guidelines recommend patient self-management (PSM) over other warfarin dosing management methods. Despite this, PSM remains virtually nonexistent in the United States (US) healthcare system. We gathered perspectives and opinions about PSM from patients who participated in a PSM implementation study in three US healthcare systems. Interviews were conducted with patients from three different US healthcare systems. Thematic qualitative analysis informed by the Consolidated Framework for Implementation Research (CFIR) was performed on interview transcripts to explore patient-perceived benefits and challenges of PSM in the US. Fifteen patients participated in individual interviews. Six major themes were identified: (1) Patients found PSM easy and empowering, enhancing their autonomy, responsibility, knowledge, and control over warfarin management; (2) Patients emphasized that trust and support from clinicians was crucial to their confidence and success with PSM; (3) Patients felt PSM should be made widely available; (4) Patients felt they needed more support and training for complex or non-routine situations during PSM; (5) Inflexibility from the healthcare system, clinicians, and PSM processes were common challenges to PSM; (6) Most patients found PSM straightforward and relied on their own judgment, rarely using the provided dosing tools. Patients who participated in a PSM implementation study reported many benefits of PSM. Patients viewed PSM as an empowering approach to warfarin management that enhanced their autonomy and confidence - especially when supported by clinicians. Given the reported advantages of PSM, select patients with sufficient experience and training may benefit from being offered PSM in the US.