ArticleBMJ open quality2023
Direct oral anticoagulant (DOAC) monitoring within primary care: a quality improvement project.
Article in BMJ open quality, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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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.
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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.
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Who cites it
3 citing papers in PubMed.
- Cyclical medication management interventions in health care settings: A systematic review.Learning health systems · 2025Article
- Therapeutic Drug Monitoring of Direct Oral Anticoagulants in Patients with Extremely Low and High Body Weight-Pilot Study.Journal of clinical medicine · 2023Article
- Challenges to Laboratory Monitoring of Direct Oral Anticoagulants.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisReview
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPoor monitoring of anticoagulants is a significant area of patient safety. It can lead to the dichotomous risk of haemorrhage/clotting without appropriate counselling and monitoring. While healthcare professionals may be familiar with the anticoagulant warfarin and the international normalised ratio, they might be unaware of the monitoring requirements of direct oral anticoagulants (DOACs), despite DOACs making up 62% of anticoagulants prescribed. The goal of this quality improvement (QI) project was to increase the compliance of monitoring of DOACs within general practice (GP) to improve patient safety and reduce the risk of an adverse outcome for patients. LOCAL PROBLEM: In 2019, the GP surgery had 318 patients prescribed a DOAC and their medication reviews took place opportunistically. While initially, monitoring levels were nearly 100%, by December 2018 this had dropped significantly, and clinicians stated they were unfamiliar with this medication. METHODS AND
interventionsThis project aimed to resolve this by using QI methodology and Plan-Do-Study-Act (PSDA) cycles to create new sustainable processes with DOAC monitoring and aimed to increase DOAC monitoring by 20% within 6 months.
resultsWithin 6 months, the project improved the rate of monitoring, and 49% of all patients prescribed a DOAC were seen in a DOAC clinic (n=156) and 78% (n=230/294) had DOAC counselling; 97% (n=295/304) had appropriate blood tests and 72% (n=216/298) had a recent weight recorded within their medical records. Three years on, 600 patients within the practice are prescribed DOACs and 74% (n=445) have had an annual review adhering to the gold standards set within the project.
conclusionThis QI project confirms that monitoring of DOACs can be improved within primary care by using QI methodology and improving patient safety, using PDSA cycles, stakeholder engagement and the introduction of the anticoagulant domains within the nationwide Quality Assurance and Improvement Framework.
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