Evidence map›Paper›PMID 30397015›Full record

Trial reportThe British journal of general practice : the journal of the Royal College of General Practitioners2018

Barriers to a software reminder system for risk assessment of stroke in atrial fibrillation: a process evaluation of a cluster randomised trial in general practice.

Tim A Holt, Andrew Rh Dalton, Susan Kirkpatrick, Jenny Hislop, Tom Marshall, Matthew Fay, Nadeem Qureshi, Daniel S Lasserson, Karen Kearley, Jill Mollison and 3 more

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The British journal of general practice : the journal of the Royal College of General Practitioners, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
0.3field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Article
  6. Review
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 2 institutions in 1 country.

Tim A HoltNuffield Department of Primary Care Health Sciences, Oxford University, Oxford.
Andrew Rh DaltonPostgraduate School of Public Health, Health Education West Midlands, Birmingham.
Susan KirkpatrickNuffield Department of Primary Care Health Sciences, Oxford University, Oxford.
Jenny HislopNuffield Department of Primary Care Health Sciences, Oxford University, Oxford.
Tom MarshallInstitute of Applied Health Research, Birmingham University, Birmingham.
Matthew FayWestcliffe Medical Centre, Shipley, West Yorkshire.
Nadeem QureshiSchool of Medicine, University of Nottingham, Nottingham.
Daniel S LassersonInstitute of Applied Health Research, Birmingham University, Birmingham.
Karen KearleyNuffield Department of Primary Care Health Sciences, Oxford University, Oxford.
Jill MollisonNuffield Department of Primary Care Health Sciences, Oxford University, Oxford.
Ly-Mee YuNuffield Department of Primary Care Health Sciences, Oxford University, Oxford.
David FitzmauriceInstitute of Applied Health Research, Birmingham University, Birmingham.
Fd Richard HobbsNuffield Department of Primary Care Health Sciences, Oxford University, Oxford.
University of Oxford · GBUniversity of Nottingham · GB

Funding

Department of Health IS-SPC-0514-10043Medical Research Council G9900264
6 · The paper itself

Abstract

backgroundOral anticoagulants reduce the risk of stroke in patients with atrial fibrillation (AF), but are underused. AURAS-AF (AUtomated Risk Assessment for Stroke in AF) is a software tool designed to identify eligible patients and promote discussions within consultations about initiating anticoagulants.

aimTo investigate the implementation of the software in UK general practice. DESIGN AND

settingProcess evaluation involving 23 practices randomly allocated to use AURAS-AF during a cluster randomised trial.

methodAn initial invitation to discuss anticoagulation was followed by screen reminders appearing during consultations until a decision had been made. The reminders required responses, giving reasons for cases where an anticoagulant was not initiated. Qualitative interviews with clinicians and patients explored acceptability and usability.

resultsIn a sample of 476 patients eligible for the invitation letter, only 159 (33.4%) were considered suitable for invitation by their GPs. Reasons given were frequently based on frailty, and risk of falls or haemorrhage. Of those invited, 35 (22%) started an anticoagulant (7.4% of those originally identified). A total of 1695 main-screen reminders occurred in 940 patients. In 883 instances, the decision was taken not to initiate and a range of reasons offered. Interviews with 15 patients and seven clinicians indicated that the intervention was acceptable, though the issue of disruptive screen reminders was raised.

conclusionAutomated risk assessment for stroke in atrial fibrillation and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake.

Indexed as

General PracticeReminder SystemsSoftwareAnticoagulantsAtrial FibrillationCluster AnalysisHealth Services ResearchHumansProcess Assessment, Health CareQualitative ResearchRisk AssessmentStrokeUnited KingdomAnticoagulantsanticoagulantsatrial fibrillationelectronic health recordsreminder systemsstroke

Identifiers

PMID30397015
PMCPMC6255240
OpenAlexW2900233055

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.