The issue is that stroke and bleeding risks change over time<\/a>, so medication needs to be reviewed annually. This requires high levels of collaboration between primary and secondary care to review all eligible patient medication for drug interactions, over-the-counter medications and herbal\/alternative therapies.<\/p>\n The opportunity was to optimise the quality of care for patients on a DOAC across a locality and review if an alternative lower-priced DOAC was suitable. Carried out between October 2022 to May 2023, the work would ensure patients were on the appropriate DOAC and dose regime for their renal function, liver function, weight, co-morbidities, and medication to ensure optimal oral anticoagulant (OAC) therapy.<\/p>\n The main objectives were to optimise care for all patients prescribed a DOAC for NV-AF and to review patients’ prescribed apixaban to see if a lower-cost alternative could be used.<\/p>\n The Spirit Active Implementation\u2122 team identified all patients on existing DOAC therapy, checking patient eligibility to change through up-to-date patient blood records, calculating Creatinine Clearance, CHA2DS2-VASc7 and HAS-BLED\/ORBIT scores. They also discussed any patients with incorrect doses\/significant interactions\/safety concerns or identified issues with the appropriate clinician.<\/p>\n To fulfil the objectives, the project required continual collaboration between the Spirit Active Implementation\u2122 team with multiple GP practice staff, secondary care HCPs, and multiple stakeholders across the locality.<\/p>\n The review service not only highlighted those who were eligible to be switched to a lower-cost DOAC alternative but also identified:<\/p>\n Ultimately, the work improved patients’ care beyond the project’s original scope and highlighted additional patients who required further attention to optimise their DOAC therapy.<\/p>\n From a patient quality perspective, the project’s learnings hold promise for broader impact, potentially on a national scale. From a cost-savings lens, the works highlight potential roadblocks to scaling. However, these can be overcome using the learnings from the project.<\/p>\n Positive signs for scalability include:<\/p>\n Challenges to consider include:<\/p>\n The work demonstrates an innovative quality review project to optimise patient care for those prescribed a DOAC for AF. It offers evidence of important changes with the potential to impact multiple stakeholders.<\/p>\n Delivered change:<\/strong><\/p>\n Number of interventions identified in locality DOAC review service<\/strong><\/p>\n Potential impact:<\/strong><\/p>\n This quality review service is a compelling example of how such initiatives can improve patient outcomes, optimise healthcare systems, and empower providers.<\/strong><\/p>\n To see how Spirit Health delivers results and to learn more about their success in optimising therapy areas, please click here<\/a>.<\/p>\n
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\nScalability of work<\/h3>\n
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\nEvidence of success<\/h3>\n
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\nNext steps<\/h3>\n