Australian key stakeholder views regarding implementation of atrial fibrillation screening: a qualitative evaluation.

Abstract

OBJECTIVE: To understand the issues impacting atrial fibrillation (AF) screening and what needs to be considered for a successful national screening programme in Australia. DESIGN: Qualitative design using semistructured interviews and thematic analysis. SETTING: Australian Health. PARTICIPANTS: Six broad stakeholder groups were identified: charities/patient support, healthcare providers, professional bodies, government, research (including Indigenous health) and industry. METHODS: Semistructured interviews were conducted with 25 representative participants. Iterative thematic analysis was used. Coding was driven by the research questions (the current context; is a national screening programme warranted and approaches to a national screening programme) and an inductive approach where novel groupings of information were identified. FINDINGS: The key findings are grouped into four areas. (1) Current opportunistic general practitioner-led screening is ad hoc and fragmented. ISSUES: poor remuneration; lack of health sector collaboration and prioritisation; consumers lack awareness. (2) Systematic screening of all in-scope patients not considered feasible and concerns over lack of evidence. (3) Alternative approaches to increase screening include innovative approaches inside and outside general practice and use of smart technology. (4) Recommendations: (a) Support general practices and address remuneration and workflows; (b) Ensure a clear pathway to treatment; (c) Address data security, management and integration and sensitivity issues with wearable devices; (d) Promote collaboration between key organisations; (e) Address research gaps and (f) Generate culturally appropriate consumer education to promote consumer demand. CONCLUSIONS: Most stakeholders were broadly supportive of AF screening but agreed that current approaches were fragmented and not sufficient. If the forthcoming research evidence supports screening effectiveness on major outcomes, stakeholders envisaged a semi-systematic approach tailored to specific health settings, rather than a formalised systematic national screening programme.