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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| A qualitative study of warfarin self-management in the United States healthcare system: insights from patient experiences Spencer J.Gilbert1, 2, Heeseung Hong1, Aubrey E.Jones1, 2, Sara R.Vazquez1, 2, Geoffrey D.Barnes3, Katelyn W.Sylvester4, Daniel M.Witt1, 2. 1University of Utah College of Pharmacy, Salt Lake City, UT, USA.2University of Utah Health Thrombosis Service, Salt Lake City, UT, USA.3University of Michigan, Ann Harbor, MI, USA.4Brigham and Women's Hospital, Boston, MA, USA |
Abstract
Background: Despite the emergence of direct oral anticoagulants (DOACs), there are still indications for which warfarin has shown superior efficacy, such as antiphospholipid syndrome and stroke prevention in patients with mechanical heart valves. Furthermore, some patients elect to use warfarin over DOACs due to cost concerns or individual preferences. For the many warfarin users in the United States (US), evidence-based guidelines recommend patient self-management (PSM) over other warfarin dosing management methods. Despite this, PSM remains virtually nonexistent in the US healthcare system. Objectives: Gather perspectives and opinions about PSM from patients who participated in a PSM implementation trial in three US healthcare systems. Methods: Interviews were conducted with patients who had participated in a PSM implementation trial at three different US healthcare systems. Interviews were conducted between December 2024 and February 2025 using a semi-structured template. Each interview was transcribed verbatim using an AI transcription tool and reviewed for correctness by the interviewer. Grounded theory analysis was performed on interview transcripts to identify common themes between patient responses. Identified themes were categorized into consolidated framework for implementation research (CFIR) domains to explore patient-perceived benefits and challenges of PSM in the US. Results: Fifteen patients participated in individual interviews. Six major themes were identified from their interviews: 1) Patients found PSM easy and empowering, enhancing their autonomy, responsibility, knowledge, and control over warfarin management (CFIR domains “Intervention Characteristics”; and “Characteristics of Individuals”); 2) Patients emphasized that trust and support from clinicians – especially as a backup resource or safety net – were crucial to their confidence and success with PSM (CFIR domains “Inner Setting”; “Characteristics of Individuals”; and “Process”); 3) Patients felt PSM should be made widely available, with success more likely for those with warfarin experience, cognitive skills, and a strong sense of responsibility (CFIR domains “Outer Setting”; and “Characteristics of Individuals”); 4) Patients felt they needed more support and training for complex or non-routine situations during PSM, such as travel, borderline dosing scenarios, and procedures (CFIR domains “Intervention Characteristics”; “Inner Setting”; and “Process”); 5) Inflexibility from the healthcare system, clinicians, and processes were common challenges to PSM (CFIR domains “Inner Setting”; “Characteristics of Individuals”; and “Process”); 6) Most patients found PSM straightforward and relied on their own judgment, rarely using the provided dosing tools and expressing mixed reviews on their usefulness (CFIR domains “Intervention Characteristics”; “Characteristics of Individuals”; and “Process”). Conclusions: 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 advantages of PSM, more patients should be offered PSM in the US.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.