A qualitative study exploring patient experiences and opinions of warfarin patient self-management in the US healthcare system.

Background: Despite consensus guideline recommendations, the use of warfarin patient self-management (PSM) in the United States (US) healthcare system remains underutilized. Objectives: To gain an understanding of the barriers and facilitators to warfarin PSM in US healthcare systems through qualitative exploration of the opinions of select US patients receiving warfarin therapy. Methods: Individual patient interviews were conducted at five geographically diverse sites. Grounded theory analysis was performed on interview transcriptions using the consolidated framework for implementation research (CFIR) to identify facilitators and barriers to PSM implementation within the US healthcare system. Results: A total of 40 patients were interviewed. Four major themes emerged from the interviews: (1) "Patients are resourceful problem solvers who know themselves better than clinicians" (CFIR domain "Characteristics of Individuals"); (2) The provider-patient relationship is key to successful PSM (CFIR domains "Inner Setting" and "Intervention Characteristics"); (3) Patients are willing and interested in trying PSM if not already doing so (CFIR domains "Process," "Intervention Characteristics," "Inner Setting, and "Characteristics of Individuals"); and (4) Point-of-care international normalized ratio (INR) monitoring is an important PSM facilitator (CFIR "Intervention Characteristics," "Outer Setting," "Inner Setting," and "Process" domains). Conclusions: Interview participants were willing and interested in trying PSM. Core elements of warfarin PSM include timely access to INR results, and a framework to support PSM decision making. Home INR monitoring is likely ideal for facilitating PSM implementation as is maintaining strong provider-patient relationships where providers, including clinical pharmacists, trust their patients and act as a safety net for PSM decision making.