The following leaflet was produced for the purpose of informing patients currently taking Direct Oral Anticoagulants (DOACs) and to highlight the importance of having a regular monitoring system in place. After conducting a needs analysis on the patients at our GP placement, we gathered that they felt uninformed on how their medication functioned in their body and why monitoring was so crucial.
This leaflet is directed towards anyone currently taking DOACs (Apixaban, Edoxaban, Dabigatran and Rivaroxaban) who would like more general information as to why they are taking them and how the drug will affect their body. The leaflet introduces how they work, why you take them, adherence and side effects. We dedicated a complete side to monitoring, covering things such as frequency of appointments, reasoning behind monitoring and which parameters are measured. The back of the leaflet allows patients to write down their next appointment, serving as a reminder slip. On the front, there is a table with a checkbox for you to tick the DOAC you are taking.
This leaflet was created as part of our GP clinical attachment, so we are also displaying it in the waiting area, as well as having an electronic version that GPs can download and send to patients during consultations.
Additionally, we thought it would be beneficial to modify the practice’s current EMIS template on DOACs to focus more on monitoring. The modified template now contains a short bio reminding GPs on the indications of monitoring - in line with their Creatinine Clearance, age and risk of comorbidities. The template allows GPs to easily document patient compliance and side effects, as well as being able to book future appointments. We added a tick-box stating ‘leaflet given’, this now means that leaflets can be handed to pateint's on initiation of DOACs and in follow up appointments, this will be up and running in due course. These measures allow our work to be sustainable even after we leave the practice.
Anticoagulation UK has been a major support in project planning and implementation. They similarly recognised the need for more resources targeted towards DOAC monitoring, and with their constant support in developing and modifying the leaflet, we feel it is well catered to the patient population. A huge thanks to Frances Akor, clinical pharmacist specialising in anticoagulation and medical advisor to Anticoagulation UK, for her support, contribution and medical review. Furthermore, a huge appreciation for our patient focus groups for dedicating their time and giving critical feedback to also shape our leaflet to provide the best information it can to help other people.
Mohona Sengupta and Leena Ahmed
Year 3 Medical students at Imperial College London