Primary Care Atrial Fibrillation (PCAF) Service
by Inspira Health Solutions Ltd and Liverpool Heart and Chest Hospital
Stroke risk associated with atrial fibrilliation can be significantly reduced by appropriate preventative action. However, NICE estimate that 46% of patients who should be anticoagulated are not. The PCAF service is a pathway that provides expert resources within GP practices with the aim of improving anticoagulation among high-risk patients. To date, 42 GP practices have been enrolled, covering a population of 284,945. A total of 761 patients attending for review had anticoagulation offered, of whom 745 agreed. It is estimated about 30 strokes have been prevented.
"We are highly impressed by this entry; from its clear objectives to its planning, to the way the team showed impact and results. It is a project that is making an effort to leave a legacy in place that supports primary care. The team has developed these education and support tools so future teams can run the programme. It shows a solid project management approach designed to implement a service. This has to be the future of getting a service in primary care. It’s an excellent model that is demonstrating improvements and has shown that it works"
Educational-behavioural intervention for warfarin in atrial fibrillation patients: TREAT study
by City Hospital, University of Birmingham and Aston University
Effective stroke prevention for atrial fibrillation patients requires anticoagulation either with a vitamin K antagonist, such as warfarin, or one of the new oral anticoagulants. Efficacy of warfarin requires maintenance of a narrow therapeutic target, which is often poorly controlled in practice due in part to a lack of understanding about treatment. The team developed an intensive-educational intervention for AF patients. The intervention consists of a one-off group session and a DVD featuring patient interview clips discussing concerns about AF and oral anticoagulants. Compared to usual care the intervention led to significant improvements in patients’ understanding of the necessity of warfarin and reduced their perception of treatment harm.
"This is a good piece of work that is trying to make a difference around education for patients, and showed real improvements. Patient education is a central issue in anticoagulation going forward and this is a worthy entry."