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BACKGROUND: Clinical trials suggest that oral anticoagulation therapy (OAT) self-monitoring is safe and effective, however little is known about the patient experience of this process. There is a lack of understanding about how best to train and support patients embarking on OAT self-monitoring. AIM: To collect in-depth information about patients' experiences of OAT self-monitoring outside of clinical trial conditions and to produce a set of recommendations on how best to support such patients. DESIGN AND SETTING: Semi-structured qualitative interviews with patients who self-monitor and live in England. METHOD: In total, 26 of the 267 (9.7%) who participated in the Cohort study of Anticoagulation Self-Monitoring (CASM) and were still self-monitoring after 12 months' follow-up were interviewed. Topics discussed included experiences of OAT self-monitoring, healthcare support, training, and decision making. Framework analysis was used. RESULTS: Following initial problems using the monitoring device, interviewees described a mostly positive experience. Although less effort was expended attending monitoring appointments with health professionals, effort was required to conduct self-monitoring tests and to interpret and act on the results. Desire to self-manage was variable, especially when dosing advice systems worked promptly and reliably. Interviewees overcame patchy healthcare system knowledge and support of self-monitoring by educating themselves. Family and friends provided support with learning to use the monitor and managing OAT dosage adjustments. CONCLUSION: Better, more-consistent training and health-service support would have alleviated a number of problems encountered by these patients who were self-monitoring. This training and support will become even more important if self-monitoring becomes more accessible to the general population of people on OAT.

Original publication




Journal article


Br J Gen Pract

Publication Date





e438 - e446


anticoagulants, primary care, qualitative research, self-management, self-monitoring, Administration, Oral, Adult, Aftercare, Aged, Anticoagulants, Drug Monitoring, England, Female, Follow-Up Studies, Humans, Incidence, International Normalized Ratio, Male, Middle Aged, Patient Education as Topic, Primary Health Care, Qualitative Research, Self Care, Stroke, Surveys and Questionnaires, Time Factors