Multi-Disciplinary Decision Making In General Practice- A Case Study Of Switching Between Oral Anticoagulants

Abstract

As the prevalence of chronic conditions and co-morbidities increase complex long-term conditions, management responses are required. Such responses require an integrated approach to care. This necessitates a multi-disciplinary approach to decision making when treating patients with Atrial Fibrillation (AF). While the European Society of Cardiology guidelines (Kirchhof, 2017) advocate a structured integrated approach to care, that is patient-centred with multidisciplinary teams, the collaboration needs to be meaningful and appropriate. It is important to determine if General Practitioners (GPs) are collaborating in the multidisciplinary decision making when switching between oral anticoagulants (OACs) for AF patients. This paper explores Irish GPs’ experience of switching between OACs, the prevalence of multi-disciplinary decision making and determines what GP characteristics influence the likelihood of multi-disciplinary decision making in the community. Primary data was used and a probit and multinomial logit applied to determine the factors influencing the likelihood of multi-disciplinary decision-making for OAC switching decisions. While 88% of GPs in the survey indicated they had AF patients whose OAC was switched, only 64% of GPs indicated the decisions involved more than one decision maker, i.e. were multidisciplinary. Female GPs and GPs who initially prescribed OACs were more likely to engage in multidisciplinary decision-making surrounding switching OACs amongst AF patients. The latter characteristic suggests a greater sense of appreciation of the complexities and pharmacokinetic/pharmacodynamic characteristics of OACs, which is unsurprising. This case study reveals that some multidisciplinary decision-making is occurring, but it is not standard practice. Moreover there is a lack of patient participation in the decision making process. As indicated by Kirchhof (2017) integrated care, with coordinated multidisciplinary decision-making, has the potential to provide continued care in the community. Knowledge of these prescribing decisions is necessary to promote optimal use of OACs and in particular costly NOACs and to ensuring patient-centred care.