TY - JOUR
T1 - Health care professionals' perceptions about atrial fibrillation care in the Brazilian public primary care system
T2 - a mixed-methods study
AU - Paschoal, Elisabete
AU - Gooden, Tiffany E.
AU - Olmos, Rodrigo D.
AU - Lotufo, Paulo A.
AU - Benseñor, Isabela M.
AU - Manaseki-Holland, Semira
AU - Lip, Gregory Y. H.
AU - Thomas, G. Neil
AU - Jolly, Kate
AU - Lancashire, Emma
AU - Lane, Deirdre A.
AU - Greenfield, Sheila
AU - Goulart, Alessandra C.
AU - NIHR Global Health Research Group on Atrial Fibrillation Management
N1 - © 2022. The Author(s).
PY - 2022/12/22
Y1 - 2022/12/22
N2 - BACKGROUND: Atrial fibrillation (AF) negatively impacts health systems worldwide. We aimed to capture perceptions of and barriers and facilitators for AF care in Brazilian primary care units (PCUs) from the perspective of healthcare professionals (HCPs).METHODS: This mixed-methods, cross-sectional study utilised an exploratory sequential design, beginning with the quantitative data collection (up to 18 closed questions) immediately followed by a semi-structured interview. HCPs were recruited from 11 PCUs in the Sao Paulo region and included managers, physicians, pharmacists, nurses and community health agents. Descriptive statistics were used to present findings from the quantitative questionnaire and inductive analysis was used to identify themes from the qualitative data.RESULTS: One hundred seven HCPs were interviewed between September 2019 and May 2020. Three main themes were identified that encapsulated barriers and facilitators to AF care: access to care (appointments, equipment/tests and medication), HCP and patient roles (HCP/patient relationship and patient adherence) and the role of the organisation/system (infrastructure, training and protocols/guidelines). Findings from the qualitative analysis reinforced the quantitative findings, including a lack of AF-specific training for HCPs, protocols/guidelines on AF management, INR tests in the PCUs, patient knowledge of AF management and novel oral anticoagulants (NOACs) as key barriers to optimal AF care.CONCLUSIONS: Development and implementation of AF-specific training for PCU HCPs are needed in Brazil, along with evidence-based protocols and guidelines, educational programmes for patients, better access to INR tests for patients taking warfarin and availability of NOACs.
AB - BACKGROUND: Atrial fibrillation (AF) negatively impacts health systems worldwide. We aimed to capture perceptions of and barriers and facilitators for AF care in Brazilian primary care units (PCUs) from the perspective of healthcare professionals (HCPs).METHODS: This mixed-methods, cross-sectional study utilised an exploratory sequential design, beginning with the quantitative data collection (up to 18 closed questions) immediately followed by a semi-structured interview. HCPs were recruited from 11 PCUs in the Sao Paulo region and included managers, physicians, pharmacists, nurses and community health agents. Descriptive statistics were used to present findings from the quantitative questionnaire and inductive analysis was used to identify themes from the qualitative data.RESULTS: One hundred seven HCPs were interviewed between September 2019 and May 2020. Three main themes were identified that encapsulated barriers and facilitators to AF care: access to care (appointments, equipment/tests and medication), HCP and patient roles (HCP/patient relationship and patient adherence) and the role of the organisation/system (infrastructure, training and protocols/guidelines). Findings from the qualitative analysis reinforced the quantitative findings, including a lack of AF-specific training for HCPs, protocols/guidelines on AF management, INR tests in the PCUs, patient knowledge of AF management and novel oral anticoagulants (NOACs) as key barriers to optimal AF care.CONCLUSIONS: Development and implementation of AF-specific training for PCU HCPs are needed in Brazil, along with evidence-based protocols and guidelines, educational programmes for patients, better access to INR tests for patients taking warfarin and availability of NOACs.
KW - Administration, Oral
KW - Anticoagulants/adverse effects
KW - Atrial Fibrillation/diagnosis
KW - Brazil
KW - Cross-Sectional Studies
KW - Health Personnel
KW - Humans
KW - Primary Health Care
KW - Questionnaire
KW - Atrial fibrillation
KW - Healthcare professionals
KW - Qualitative
KW - Primary care
KW - Mixed-methods
KW - LMIC
UR - http://www.scopus.com/inward/record.url?scp=85144857462&partnerID=8YFLogxK
U2 - 10.1186/s12872-022-02927-9
DO - 10.1186/s12872-022-02927-9
M3 - Journal article
C2 - 36550397
SN - 1471-2261
VL - 22
JO - BMC Cardiovascular Disorders
JF - BMC Cardiovascular Disorders
IS - 1
M1 - 559
ER -