Assignment 6 Forum

Christine,

I can't answer for Elvin, but your homework seems correct to me!

My main concern is that it feels like you're putting a lot of emphasis on the educational part of the intervention, with the assumption that if physicians better identify risk factors they'll prescribe more anticoagulants. However, with the growing emphasis on overprescription and reducing the burden of treatment, many physicians aren't following guidelines in order to avoid prescribing multiple medications at once. 

I think it would be interesting to see how highly physicians prioritize anticoagulation when confronted with the possibility of prescribing multiple guideline indicated medications. Like, a 70-year old patient taking Aspirin and Metformin has a HbA1c of 9.0% and atrial fibrillation. You want to start insulin, an anticoagulant, both or neither? I think the anticoagulation will do more for mortality, but physicians might not agree. Maybe too complicated, but a thought.

Hi Christine,

I was saying this to Kevin too that this week's assignment seems really confusing.

I asked Elvin and Xiao responded that she had similar questions and forwarded me the following answer:

"Thanks, yes. I will clarify that.  Imagine you are doing a mixed methods project – the guide has to be assembled before the intervention has been implemented – so you have to say what you think will happen, how you will measure it, as well as a plan for measuring what you don’t know will happen! "

And Xioa added: “So, you are coming up with an interview guide apriori, to understand possible outcomes from implementation of your intervention. Hope this helps.”

The way I understand it is that the guide will inquire stakeholders' thoughts on what we think will happen with our intervention.

So I think your questions will work at getting that.

Best,

Kadi

Hi Christine,

Good work! I think your questions are strong and will elicit the appropriate response from the clinicians. I think you should maybe consider alternative medications that the clinicians might prescribe if they are unsure about anti-coagulants for this population. I like Kevin's idea of providing scenarios, but maybe you could ask them for a scenario in which they would prescribe OAC for patients with AF and when they would not prescribe OAC. This might have some useful results. Just a thought but overall well done.