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'Don’t wait to anticoagulate' project

I was interested to read the news story ‘Many atrial fibrillation patients at risk of stroke treated with aspirin over anticoagulants’ (The Pharmaceutical Journal online, 24 June 2016), which outlines the finding that significant numbers of patients with atrial fibrillation (AF) are not being prescribed the most effective form of oral anticoagulation.

The challenge of improving the identification and management of AF in our population has been taken up by Academic Health Science Networks (AHSNs) in England, alongside a range of other improvement areas.

Here at the West of England AHSN, we have worked with our member organisations to develop an approach aimed at optimising the anticoagulation of people with AF in primary care. This project, named Don’t wait to anticoagulate, has been developed in conjunction with patients, clinical staff and commissioners to identify and address barriers to effective anticoagulation. The key barriers identified were variations in clinical confidence in prescribing the range of anticoagulants, as well as in having conversations to support shared decision making.

Various approaches to addressing these barriers and thereby improving anticoagulation were designed and tested in a pilot quality improvement project in 11 ‘innovator practices’. Running for three months, this pilot reduced inappropriate antiplatelet use in high-risk patients from 454 to 373 (-16.96%). Concurrently, anticoagulation use for high-risk patients increased from 1,479 to 1,612 (+8.99%). Following a detailed evaluation, it was determined that an approach working with practice pharmacists to embed change was the most sustainable.

Following on from this, the approach has been tested at scale in partnership with 51 practices in the Gloucestershire clinical commissioning group area. Although this phase of the project is currently being evaluated, early indications are that antiplatelet use has reduced to a comparable degree.

Finally, since the role of AHSNs is to test locally and share nationally, many of our sister AHSNs across the country have elected to include ‘Don’t wait to anticoagulate’ as a key element of their local strategy.

Readers wanting more information about the project can contact me via email at

Stephen Ray

Quality improvement programme manager

West of England Academic Health Science Networks

Citation: Clinical Pharmacist DOI: 10.1211/CP.2016.20201518

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