Warfarin management after discharge from hospital: a qualitative analysis

What is Known and Objective: Warfarin is recognized as a high‐risk medication for adverse events, and the risks are particularly heightened in the period immediately following a patient’s discharge from hospital. This qualitative study aimed to explore the experiences of Australian patients and healthcare professionals of warfarin management in the post‐discharge period and identify the benefits and deficiencies of existing systems, to inform the development of a model for a new collaborative post‐discharge warfarin management service. Methods: Healthcare professionals, professional organization representatives and patients recently discharged from hospital taking warfarin (consumers) were recruited via purposive, criterion‐based sampling within two Australian states. Semi‐structured telephone interviews were conducted between August and October 2008 using standard discussion guides. Data were manually analyzed to identify emergent themes using a phenomenological approach. Results: Forty‐seven participants were involved in the telephone interviews. Three major themes emerged: (i) appropriate warfarin education is integral to effective warfarin management, (ii) problems occur in communication along the continuum of care and (iii) home‐delivered services are valuable to both patients and healthcare professionals. Discussion: Although high‐quality warfarin education and effective communication at the hospital–community interface were identified as important in post‐discharge warfarin management, deficiencies were perceived within current systems. The role of home‐delivered services in ensuring timely follow‐up and promoting continuity of care was recognized. Previous studies exploring anticoagulation management in other settings have identified similar themes. Post‐discharge management should therefore focus on providing patients with a solid foundation to minimize future problems. What is New and Conclusion: Addressing the three identified facets of care within a new, collaborative post‐discharge warfarin management service may address the perceived deficiencies in existing systems. Improvements may result in the short‐ and longer‐term health outcomes of patients discharged from hospital taking warfarin, including a reduction in their risk of adverse events.