| Summary: | Self-care is considered a means of meeting the challenge of providing care to patients with long-term conditions. However this has not achieved widespread penetration in the UK, the reasons for which are unclear. This research examined one area of self-care in depth - self-monitoring of oral anticoagulation therapy. The aim was to derive the requirements for an anticoagulation patient self-monitoring service from an analysis of the drivers for, the benefits of, the barriers to, and the challenges of establishing this service from the perspectives of key stakeholders – patients, healthcare professionals and healthcare managers. Qualitative and quantitative techniques - interviews, semi-structured questionnaire survey and focus groups – were used to gain an in-depth understanding of their views. From triangulated results, the candidate requirements for an anticoagulation self-monitoring service were derived, presented in Donabedian’s framework: structure, process and outcome. Most of these requirements were then validated through a pilot self-monitoring service. All stakeholder groups supported anticoagulation self-monitoring. However, financial, clinical and legal barriers were identified. 53% of surveyed patients were willing to undertake self-monitoring. However, only 17% of respondents felt able to purchase a coagulometer, a significant barrier. Lack of confidence in the ability to self-test was also demonstrated. Healthcare staff welcomed self-monitoring as a way to increase capacity and support evolution in the healthcare landscape. There were concerns about affordability to all stakeholders, the potential for increased clinical risk through sharing care with patients, and a fear of litigation compounded by a lack of clarity in the medicolegal position. Patient education and support were essential requirements, to prepare the patient, and on an ongoing basis. Primary care professionals felt expert support was essential for them to deliver this service. A definitive set of service requirements is proposed, and the implications of this research for other long term conditions discussed.
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