This qualitative study examined Australian general practitioners’ perspectives on initiating oral anticoagulation for stroke prevention in patients with atrial fibrillation and explored how GPs assess and monitor long-term medication adherence and persistence. The work aimed to identify clinician- and system-level barriers to initiating anticoagulants and the practical approaches used in primary care to support ongoing therapy.
Researchers recruited GPs from a larger survey of anticoagulation practices. Data collection used semi-structured interviews conducted online. Interviews were audio-recorded and transcribed verbatim. Analysis followed thematic analysis with inductive coding. Multiple researchers conducted analysis independently and reached consensus through team discussion. Interviews continued until the investigators assessed that thematic saturation had been achieved.
The abstract reports these high-level methods; detailed information on the interview guide, sampling frame, GP demographics, and coding framework are not provided in the abstract and would be found in the full text.
Fourteen GPs were interviewed. Across participants, approaches to initial management of atrial fibrillation and to initiating oral anticoagulants varied rather than following a single standardised pathway. Respondents identified both system- and patient-level factors that influenced decisions to start anticoagulation and affected how adherence and persistence were monitored over time.
GPs reported several barriers that could delay or complicate initiation of oral anticoagulation. Limited access to diagnostic services—specifically echocardiography—and restricted or delayed access to cardiology consultation were identified as important system-level constraints. Concern about patient bleeding risk was a prominent clinical barrier influencing decisions about whether and when to start anticoagulation. The abstract highlights these as recurrent themes across interviews.
Assessing and monitoring long-term adherence and persistence with oral anticoagulants was described as challenging by participating GPs. Particular patient groups were noted to be at higher risk for poor adherence: those with low health literacy, cognitive impairment, complex polypharmacy, and financial constraints that may impede ongoing access to medicines. The abstract indicates that sustained monitoring was difficult to maintain in routine primary care for these patients.
GPs described a range of strategies they used to monitor and attempt to improve adherence and persistence with oral anticoagulation. These included:
The abstract reports these strategies as those commonly used by participants; specific details on effectiveness or frequency of each approach are not reported in the abstract.
Australian GPs reported multiple challenges when initiating and monitoring oral anticoagulation for stroke prevention in patients with atrial fibrillation. The study authors suggest that enabling GPs to confidently start oral anticoagulants without routinely delaying for diagnostic testing or cardiology review, improving access to echocardiography services, and providing support for ongoing adherence and persistence monitoring may contribute to reducing stroke incidence among people with atrial fibrillation.
These implications focus on system changes (access to diagnostics and specialist support) and practice supports (tools to monitor adherence, multidisciplinary involvement) that could address barriers identified by GPs.
The abstract reports the study design, sample size (fourteen GPs), analytic approach and principal thematic findings. It does not provide participant demographic details, the full interview schedule, verbatim exemplar quotations, or granular coding outcomes; those specifics are in the full text. No quantitative outcome data or measures of intervention impact are presented in the abstract. Readers seeking detailed methods, participant characteristics and illustrative quotes should consult the published article (Aust J Prim Health; doi: 10.1071/PY26067).