Prevention of hospital-acquired thrombosis from a primary care perspective: a qualitative study.
Litchfield I., Fitzmaurice D., Apenteng P., Harrison S., Heneghan C., Ward A., Greenfield S.
BACKGROUND: Although there is considerable risk for patients from hospital-acquired thrombosis (HAT), current systems for reducing this risk appear inefficient and have focused predominantly on secondary care, leaving the role of primary care underexplored, despite the onset of HAT often occurring post-discharge. AIM: To gain an understanding of the perspectives of primary care clinicians on their contribution to the prevention of HAT. Their current role, perceptions of patient awareness, the barriers to better care, and suggestions for how these may be overcome were discussed. DESIGN AND SETTING: Qualitative study using semi-structured interviews in Oxfordshire and South Birmingham, England. METHOD: Semi-structured telephone interviews with clinicians working at practices of a variety of size, socioeconomic status, and geographical location. RESULTS: A number of factors that influenced the management of HAT emerged, including patient characteristics, a lack of clarity of responsibility, limited communication and poor coordination, and the constraints of limited practice resources. Suggestions for improving the current system include a broader role for primary care supported by appropriate training and the requisite funding. CONCLUSION: The role of primary care remains limited, despite being ideally positioned to either raise patient awareness before admission or support patient adherence to the thromboprophylaxis regimen prescribed in hospital. This situation may begin to be addressed by more robust lines of communication between secondary and primary care and by providing more consistent training for primary care staff. In turn, this relies on the allocation of appropriate funds to allow practices to meet the increased demand on their time and resources.