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Review
. 2020 Sep;28(9):452-456.
doi: 10.1007/s12471-020-01436-8.

Organisation of care for patients using direct oral anticoagulants

A J W Gulpen  1   2   3 , J K van Dijk  4 , N L Damen  5 , H Ten Cate  6   7   8 , S Schalla  7   9 , A J Ten Cate-Hoek  6   7
Affiliations
Review

Organisation of care for patients using direct oral anticoagulants

A J W Gulpen et al. Neth Heart J. 2020 Sep.

Abstract

Direct oral anticoagulants (DOACs) are recommended by several scientific societies as first-line therapy for the prevention of stroke and systemic embolism in patients with atrial fibrillation. However, there is uncertainty regarding the organisation of anticoagulation care, with various caregivers being involved. Patients and caregivers are often confronted by uncertainty about the coordination of treatment. With the functional resonance analysis method we visualised the process of anticoagulation care in daily practice in the Maastricht region. This resulted in recommendations on how to improve the organisation of anticoagulation care for DOAC patients.

Keywords: Anticoagulation care; Atrial fibrillation; Direct oral anticoagulation; Functional resonance analysis method.

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Conflict of interest statement

H. ten Cate is Chair of the Federation of Dutch Anticoagulation Clinics (FNT). He received research support from Bayer and Pfizer and consultancy fees from Bayer, Pfizer, LEO and Alveron. A.J.W. Gulpen, J.K. van Dijk, N.L. Damen, S. Schalla and A.J. ten Cate-Hoek declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The functional resonance analysis method (FRAM) function with all aspects. (To do X can represent any activity). I  Input: what the activity starts or changes, O Output: the result of the activity, P Condition: a condition that must be present before the activity can be performed, R Source: material required to perform the activity, or used during the performance of the activity, C Control: how the activity is monitored, guidelines, T Time: time aspects that influence the activity
Fig. 2
Fig. 2
Work-as-done FRAM model of the organisation of care for patients using direct oral anticoagulants (DOACs), beginning in the left part of the figure with prescription of a DOAC by a medical specialist or GP (1, 2). Then the patient goes to the pharmacy to pick up the DOAC (3, 4). Thereafter, the patient starts taking the DOAC (5), and monitoring is done by various healthcare providers in primary or secondary care (6–9). (HCP healthcare professionals)
See this image and copyright information in PMC

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