Hi, please find my assignment 2 attached. The first page includes the identification of the gap from last week, and the gap analysis starts on page 2.
Hi Christine,
Very thorough and well done for this assignment. I agree that the COM-B seems to be the best fit and is most useful for your particular gap. Addressing this from the providers perspective is definitely going to most likely yield the greatest result in closing your gap. Here are just a few thoughts to consider: is bombarding the provider with information/knowledge the best means to change their practice of underprescirption of OAC? How would you attempt to approach this gap initially? Sending information to providers, posting up signs, notes in the EHR? I want you to think about what would be the most meaningful way to approach this gap via the provider. I think looking into what the incentive will be for the provider to utilize the OACs more is interesting as well as patient benefit. It is important to see how the provider will benefit as well since some might consider that prescribing more medication is just more for them to worry about. Just a few thoughts but overall this was very well done!
I like the use of the "dag" - it helps create some directionality and firmness to the diagnosis. In the next step, I think you will want to look at the literature on the reasons you have come up with in COMB - this will be interesting! Nice work.
Christine,
Excellent start to closing this gap. I am wondering if you have any knowledge about secular trends in OACs since the introduction of the N-OACs as compared to warfarin. Also, you've chosen to emphasize the provider as the point of intervention, but is there any role that patient preference plays in the under-prescribing of OACs, particularly with warfarin, which requires arduous monitoring and lifestyle changes to maintain safety.
In terms of the stated construct in your analysis, however, I'm wondering if there are other cases, for pharmaceutical interventions, that you could follow in order to attempt to understand the provider barriers. It seems at this point there is a lot of clear benefits to the intervention (as evidenced by your gap analysis), but conjecture as to why this gap exists on the provider level. For instance, the use of beta-blockers that was cited in the first lecture may provide clues as to how the uptake of this intervention increased: controlled by specialists instead of primary care providers; a clear time point (MI/stroke) around which to intervene v the use of a preventive intervention; widely promulgated guidelines (ie by the well-funded AHA).
Looking forward to discussing in class!!
-Asa