Patient and institutional-related barriers to the uptake of anticoagulation service at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Introduction: anticoagulants are essential for preventing and treating thromboembolism; however, uptake of anticoagulation services remains low in resource-limited settings, such as Kenya. Despite the recognized benefits, many patients struggle with adherence, and contributing factors remain poorly understood. This study explored patient and institution-related barriers to the uptake of anticoagulation services at Moi Teaching and Referral Hospital (MTRH), Kenya. In particular, the study focused on knowledge, adherence, satisfaction, attitudes, service quality, and access. Methods: a cross-sectional study was conducted among 282 adult patients (≥18 years) on anticoagulation therapy for at least three months. Participants were selected through consecutive sampling. Data was collected via a pre-tested, researcher-administered semistructured questionnaire. Quantitative data were analyzed descriptively, and qualitative responses were thematically analyzed. Results: while nearly 70% of participants could identify their anticoagulant, only 42.6% of the respondents understood how diet, drug interactions, or missed doses affected treatment. Only 33.5% of the participants maintained therapeutic International Normalized Ratio (INR) levels. Non-adherence was reported in 40% of patients, with frequent missed doses and irregular clinic visits. Confusion about follow-up and INR monitoring was common, with 31.7% of patients reporting uncertainty about their medication regimen and 9.3% not knowing it at all; clinicians and pharmacists cited inadequate time (65.4%), lack of structured education programs (58.2%), and limited patient engagement tools (42.1%) as key barriers. Conclusion: despite high patient satisfaction and trust in providers, significant gaps in knowledge, adherence, and system support hinder optimal anticoagulation care. Gender and age-related disparities further complicate service uptake. Strengthening patient education, improving INR monitoring awareness, and integrating structured counseling into care models are crucial to improving anticoagulation outcomes in resource-limited settings like MTRH.