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. 2022 Dec 22;22(1):559.
doi: 10.1186/s12872-022-02927-9.

Health care professionals' perceptions about atrial fibrillation care in the Brazilian public primary care system: a mixed-methods study

Elisabete Paschoal  1 , Tiffany E Gooden  2 , Rodrigo D Olmos  1   3 , Paulo A Lotufo  1   3 , Isabela M Benseñor  1   3 , Semira Manaseki-Holland  2 , Gregory Y H Lip  2   4   5 , G Neil Thomas  2 , Kate Jolly  2 , Emma Lancashire  2 , Deirdre A Lane  6   7 , Sheila Greenfield  2 , Alessandra C Goulart  8 ; NIHR Global Health Research Group on Atrial Fibrillation Management
Collaborators, Affiliations

Health care professionals' perceptions about atrial fibrillation care in the Brazilian public primary care system: a mixed-methods study

Elisabete Paschoal et al. BMC Cardiovasc Disord. .

Abstract

Background: Atrial fibrillation (AF) negatively impacts health systems worldwide. We aimed to capture perceptions of and barriers and facilitators for AF care in Brazilian primary care units (PCUs) from the perspective of healthcare professionals (HCPs).

Methods: This mixed-methods, cross-sectional study utilised an exploratory sequential design, beginning with the quantitative data collection (up to 18 closed questions) immediately followed by a semi-structured interview. HCPs were recruited from 11 PCUs in the Sao Paulo region and included managers, physicians, pharmacists, nurses and community health agents. Descriptive statistics were used to present findings from the quantitative questionnaire and inductive analysis was used to identify themes from the qualitative data.

Results: One hundred seven HCPs were interviewed between September 2019 and May 2020. Three main themes were identified that encapsulated barriers and facilitators to AF care: access to care (appointments, equipment/tests and medication), HCP and patient roles (HCP/patient relationship and patient adherence) and the role of the organisation/system (infrastructure, training and protocols/guidelines). Findings from the qualitative analysis reinforced the quantitative findings, including a lack of AF-specific training for HCPs, protocols/guidelines on AF management, INR tests in the PCUs, patient knowledge of AF management and novel oral anticoagulants (NOACs) as key barriers to optimal AF care.

Conclusions: Development and implementation of AF-specific training for PCU HCPs are needed in Brazil, along with evidence-based protocols and guidelines, educational programmes for patients, better access to INR tests for patients taking warfarin and availability of NOACs.

Keywords: Atrial fibrillation; Brazil; Healthcare professionals; LMIC; Mixed-methods; Primary care; Qualitative; Questionnaire.

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Conflict of interest statement

GYHL: Consultant and speaker for BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally.

DAL: Investigator-initiated educational grants from Bristol-Myers Squibb (BMS), speaker for Bayer, Boehringer Ingeheim, and BMS/Pfizer; Consultant for BMS, and Boehringer Ingelheim.

Other authors: Declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Structure of primary care units in the Butantan area of Sao Paulo, Brazil. Dotted arrows represent healthcare professionals that are sometimes available. Healthcare professionals in red represent the difference between the models
See this image and copyright information in PMC

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