A nurse‐coordinated integrated care model to support decision‐making and self‐care in patients with atrial fibrillation: A study protocol

Abstract Aim This study aims to evaluate the effects of a nurse‐coordinated, empowerment‐based integrated care model on self‐care behaviours and psychosocial outcomes in patients with atrial fibrillation and to explore how this intervention affects patients’ self‐care behaviours and quality of life. Design This mixed‐methods study comprises a randomized controlled trial and an exploratory qualitative study. Methods A total of 392 community‐dwelling patients aged ≥65 years with a confirmed diagnosis of atrial fibrillation, a high stroke risk and no oral anticoagulants treatment will be recruited from the medical outpatient clinics of a university‐affiliated hospital. The patients will be randomly allocated to intervention or control groups, which will receive treatment via the nurse‐coordinated integrated care model or standard care, respectively. We hypothesize that compared with patients receiving standard care, atrial fibrillation patients exposed to the nurse‐coordinated care model will be more likely to achieve compatible patient and physician decisions regarding the use of oral anticoagulants, better changes in medication adherence, anxiety, depression and health‐related quality of life after the intervention. A subsample of 30 participants in the intervention group will also participate in a qualitative interview to provide their views and perceptions about the intervention. The ethical approval has obtained on 5 July 2018. This study is supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region on 29 June 2018. Discussion This study will uniquely adopt an empowerment‐based approach to equip patients as active agents in atrial fibrillation management through a nurse‐coordinated integrated care model that comprehensively addresses their needs. Impact Patients with atrial fibrillation are currently receiving inadequate guideline‐recommended care. This study will address this important evidence‐practice gap by optimizing oral anticoagulant prescription and therapeutic effects and promotes effective patient self‐care, so as to achieve worldwide reductions in atrial fibrillation‐related morbidity, mortality, and healthcare burdens. Clinical Trial Registration This study has been registered at ClinicalTrials.gov (NCT03924739).