Exploring the role of community pharmacists in perioperative management of antithrombotic agents: a qualitative study of barriers, facilitators, and future directions

Abstract

Introduction: Antithrombotic agents are considered as high-risk medications, particularly during the perioperative period, because of the increased risk of bleeding. Balancing bleeding and thrombosis risks is crucial in the context of invasive procedures. The specific role of community pharmacists (CPs) in perioperative antithrombotic management remains unclear.

Aim: This study aimed to explore the role of CPs in perioperative antithrombotic management, focusing on their experiences, and the barriers and facilitators to expand their involvement.

Method: A qualitative study was conducted in Belgium between March and May 2024 using semi-structured, in-depth interviews with CPs. The Theoretical Domains Framework guided the development of the interview guide to ensure comprehensive coverage of relevant domains. Interviews were transcribed verbatim and analysed thematically using open and axial coding in NVivo 14 by two independent researchers. Participants were randomly sampled and recruited until no new themes were generated.

Results: A total of 13 CPs (7 female; median age 48 years, IQR 34-58) participated in the in-depth interviews. Four key themes emerged: (i) current involvement of CPs in perioperative antithrombotic management, (ii) factors influencing CPs' role, (iii) aspirations and perceived opportunities for role expansion, and (iv) proposed strategies to optimise CPs' contributions. CPs described their current role as limited and mainly reactive, with their involvement typically occurring postoperatively. Reported barriers included insufficient knowledge of antithrombotic protocols, time constraints, inconsistent and non-transparent hospital guidelines, lack of access to relevant medical records, and difficulty reaching hospital-based prescribers. Facilitators included CPs' unique position to oversee a patient's full medication regimen, strong and trusted patient relationships, early post-discharge contact, and intrinsic motivation to contribute more actively. Participants expressed a desire for more proactive and collaborative involvement, supported by structured training. They also stressed the importance of clear, well-accessible guidelines that are as uniform as possible across hospitals. Lastly, they emphasised the need for better accessibility to prescribers to facilitate more effective communication.

Conclusion: CPs' role in perioperative antithrombotic management is currently limited, particularly preoperatively. Addressing identified barriers and implementing the suggested improvements could strengthen their role. Further research is needed to validate these findings and guide future interventions.

Keywords: Antithrombotic agents; Community pharmacy services; Perioperative care; Qualitative research.