Implementing evidence based medicine in general practice: audit and qualitative study of antithrombotic treatment for atrial fibrillation

Objective To determine the extent to which implementation of an evidence ba sed treatment, antithrombotic treatment in atrial fibrillation, is possible in general practice. Design Audit and qualitative study of patients with atrial fibrillation and an educational intervention for patients judged eligible for antithromboti c treatment Setting South east England. Subjects 56 patients with a history of atrial fibrillation. Interventions Assessment and interview to ascertain patients' views on anti thrombotic treatment Main outcome measures Number of patients receiving antithrombotic treatment Results Out of 13 239 patients, 132 had a history of atrial fibrillation of which 100 were at risk of thromboembolism. After the study, 52 patients we re taking warfarin. Of the remaining 48 patients (of whom 41 were taking as pirin), eight were too ill to participate, 16 were unable to consent, four refused the interview and 20 declined warfarin. Patients declining warfarin were inclined to seek a higher level of benefit than those taking it, as m easured by the minimal clinically important difference. Qualitative data ob tained during the interviews suggested that patients' health beliefs were i mportant factors in determining their choice of treatment Conclusion Patients' unwillingness to take warfarin seemed to be a major fa ctor in limiting the number who would eventually take it.