Stroke Circulatory System Stroke, not specified as haemorrhage or infarction
Conditions
Interventions
Intervention will have a piece of software activated in their primary carer databases. The software will generate a list of all patients registered in the practice diagnosed with atrial fibrillation,
Sponsors
University of Oxford (UK)
Eligibility
Inclusion criteria
Inclusion criteria: 1. Practices using clinical software compatible with the intervention (i.e. the EMIS-Web system) 2. Within the study region, namely covering the South East of England, Central England and East Midland & South Yorkshire Primary Care Research Networks (PCRNs) 3. Within participant practices, outcome data will be recorded in patients with diagnosed atrial fibrillation, who justify anticoagulation according to the criteria in NICE guidance TA249 For the pilot study the above criteria (as well as the exclusion criteria below) apply, simply confined to the Thames Valley research partnership area.
Exclusion criteria
Exclusion criteria: The practice may not enter the study if ANY of the following apply: 1. Practices using other clinical software systems than EMIS-Web 2. Practices have recently (within the last 2 years) carried out a major audit of OAC prescribing in eligible patients, including the systematic invitation of patients, using bespoke software tool such as GRASP-AF 3. Practices previously involved in a trial concerning anticoagulation in AF 4. For the main phase of the trial, practices participating in the pilot will be excluded
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Proportion of patients with diagnosed AF and eligible for anticoagulation under recent guidelines (NICE TA249) who are prescribed this therapy six months after the start of the intervention | — |
Secondary
| Measure | Time frame |
|---|---|
| Main phase: 1. Proportion of patients with CHADS2 score =2 who are prescribed anticoagulants 2. Record of inappropriate care or prescribing decisions related to anticoagulation in patients with AF 3. Incidence of stroke, transient ischaemic attack (TIA), other major thromboembolism or major haemorrhage during the trial 4. Outcomes of the discussion of/ decisions about the prescription of anticoagulants - including number of patients eligible/invited for a discussion about anticoagulation/reasons for not inviting patients/number attending discussion/outcomes of discussion/reasons for not to using OAC Pilot study: 1. Limitations to usability and appropriateness of intervention and trial material [to improve the intervention, not directly answer objectives 2. Ease of adoption of electronic system by primary care team Process evaluation: 1. Responses to screen reminders 2. Patient views on opportunistic (using the electronic reminders) and systematic (from the invitation of the eligible list) approaches to anticoagulant prescribing, and views on the appropriateness and usefulness of electronic reminders 3. Practitioner views on the use of electronic reminders and audit lists of eligible patients to promote anticoagulant prescribing, and of their impact on the consultation process | — |
Countries
United Kingdom
Outcome results
None listed