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General Practice

Implementing evidence based medicine in general practice: audit and qualitative study of antithrombotic treatment for atrial fibrillation

BMJ 1999; 318 doi: (Published 15 May 1999) Cite this as: BMJ 1999;318:1324
  1. Alistair Howitt, principal in general practice (ajhowitt{at},
  2. David Armstrong, reader in sociology as applied to medicineb
  1. aWarders Medical Centre, Tonbridge, Kent TN9 1LA
  2. bDepartment of General Practice, Guy's, King's And St Thomas' School of Medicine, London SE11 6SP
  1. Correspondence to: Dr Howitt
  • Accepted 31 March 1999


Objective: To determine the extent to which implementation of an evidence based treatment, antithrombotic treatment in atrial fibrillation, is possible in general practice.

Design: Audit and qualitative study of patients with atrial fibrillation and an educational intervention for patients judged eligible for antithrombotic treatment.

Setting: South east England.

Subjects: 56 patients with a history of atrial fibrillation.

Interventions: Assessment and interview to ascertain patients' views on antithrombotic treatment.

Main outcome measures: Number of patients receiving antithrombotic treatment.

Results: Out of 13 239 patients, 132 had a history of atrial fibrillation of which 100 were at risk of thromboembolism. After the study, 52 patients were taking warfarin. Of the remaining 48 patients (of whom 41 were taking aspirin), eight were too ill to participate, 16 were unable to consent, four refused the interview, and 20 declined warfarin. Patients declining warfarin were inclined to seek a higher level of benefit than those taking it, as measured by the minimal clinically important difference. Qualitative data obtained during the interviews suggested that patients' health beliefs were important factors in determining their choice of treatment.

Conclusion: Patients' unwillingness to take warfarin seemed to be a major factor in limiting the number who would eventually take it.

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