Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers

PLoS One. 2021 Sep 29;16(9):e0257798. doi: 10.1371/journal.pone.0257798. eCollection 2021.


Background: Oral anticoagulants (OACs) are very commonly prescribed for prevention of serious vascular events, but are also associated with serious medication-related bleeding. Mitigation of harm is believed to require high-quality OAC management. This study aimed to identify barriers and facilitators for optimal OAC management from the perspective of patients, caregivers and healthcare providers.

Methods: Using a qualitative descriptive study design, we conducted five focus groups, three with patients and caregivers and two with health care providers, in two health regions in Southwestern Ontario. An expert facilitator led the discussions using a semi-structured interview guide. Each session was digitally recorded, transcribed verbatim and anonymized. Transcripts were analyzed in duplicate using conventional content analysis.

Results: Forty-two (19 patients, 7 caregivers, and 16 providers including physicians, nurses and pharmacists) participated. More than half of the patients received OAC for the treatment of venous thromboembolism (57.9%) and the majority (94.7%) were on chronic therapy (defined as >3 years). Data analysis organized codes describing barriers and facilitators into 4 main themes-medication-related, patient-related, provider-related, and system-related. Barriers highlighted were problems with medication access due to cost, patient difficulties with adherence, knowledge and adjusting their lifestyles to OAC therapy, provider expertise, time for adequate communication amongst providers and their patients, and health care system inadequacies in supporting communications and monitoring. Facilitators identified generally addressed these barriers.

Conclusions: Many barriers to optimal OAC management exist even in the era of DOACs, many of which are amenable to facilitators of improved care coordination, patient education, and adherence monitoring.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Anticoagulants / administration & dosage*
  • Anticoagulants / therapeutic use
  • Caregivers / psychology*
  • Female
  • Focus Groups
  • Health Personnel / psychology*
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Ontario
  • Patient Compliance
  • Practice Patterns, Physicians'
  • Qualitative Research
  • Quality of Health Care
  • Venous Thromboembolism / drug therapy*


  • Anticoagulants

Grant support

This research was supported by the Canadian Institutes of Health Research Project Grant (to AH). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.