INTRODUCTION Hospital-acquired thrombosis (HAT) is a substantial healthcare problem resulting in significant mortality, morbidity, and economic cost. 1,2 Recent estimates put the figures for hospital deaths from venous thromboembolism (VTE) in England and Wales in excess of 34 000 3 out of some 16 million admissions, 4 although the introduction of the VTE risk assessment tool has led to a reduction in these numbers. 5 It is a disorder that can occur across race, ethnicity, age group, and sex, with many of the known risk factors, such as advanced age, immobility, surgery, and obesity, on the increase. HAT can occur up to 90 days after admission, 6 yet, to date, much of the focus on preventing HAT has fallen on the secondary care environment and there is little to no understanding of the role of primary care. However, a recent study that incorporated primary care data found that over 50% of deaths from VTE occurred after hospital discharge. 7 This risk of developing HAT is influenced by the specific medical condition of the patient 8 and thromboprophylaxis has been shown to reduce the risk of VTE by 75% in surgical patients 9 and by around 50% in medical patients. 9,10 Current UK guidelines for preventing HAT 11 (Figure 1) recommend using the Department of Health’s risk assessment tool 12 to inform the prescription of the appropriate thromboprophylaxis. 13 The risk assessment tool uses factors, such as significant comorbidity, age, and pregnancy, alongside the risks associated with hospital admissions, such as reduced mobility for >3 days or undergoing surgery that lasts >60 minutes. The prophylaxis that is recommended consists of mechanical devices, such as antiembolism stockings, often used in combination with a pharmacological element including low molecular weight heparin (LMWH), sometimes prescribed for several months following surgery. 11 Previous research abroad has indicated that non-adherence to guidelines is an issue for both physicians 14 and patients. 15,16 There is some evidence of similar issues of adherence among patients in the UK, 17 with some reporting adherence to LMWHs as low as 23%. 18 The guidelines also stipulate a supporting role for GPs, based on their notification of when patients are discharged and the prophylaxis prescribed. This type of communication between care settings is known to be problematic, 19–23 leaving patients vulnerable to adverse events following discharge, 24–29 and the role performed by primary care being unclear. If primary care is to contribute more effectively to the prevention of HAT, then a better understanding of its current role and of the factors that influence this role is required. The ExPeKT study was designed to explore existing knowledge of thromboprophylaxis among patients, Research Abstract Background Although there is considerable risk for patients from hospital-acquired thrombosis (HAT), current systems for reducing this risk appear inefficient and have focused predominantly on secondary care, leaving the role of primary care underexplored, despite the onset of HAT often occurring post-discharge. Aim To gain an understanding of the perspectives of primary care clinicians on their contribution to the prevention of HAT. Their current role, perceptions of patient awareness, the barriers to better care, and suggestions for how these may be overcome were discussed. Design and setting Qualitative study using semi-structured interviews in Oxfordshire and South Birmingham, England. Method Semi-structured telephone interviews with clinicians working at practices of a variety of size, socioeconomic status, and geographical location. Results A number of factors that influenced the management of HAT emerged, including patient characteristics, a lack of clarity of responsibility, limited communication and poor coordination, and the constraints of limited practice resources. Suggestions for improving the current system include a broader role for primary care supported by appropriate training and the requisite funding. Conclusion The role of primary care remains limited, despite being ideally positioned to either raise patient awareness before admission or support patient adherence to the thromboprophylaxis regimen prescribed in hospital. This situation may begin to be addressed by more robust lines of communication between secondary and primary care and by providing more consistent training for primary care staff. In turn, this relies on the allocation of appropriate funds to allow practices to meet the increased demand on their time and resources. Keywords prevention and control; primary health care; qualitative research; thrombosis. I Litchfield, MSc, PhD, clinical lead, Institute of Applied Health Research; D Fitzmaurice, MD, FRCGP, clinical lead, Primary Care Clinical Sciences; P Apenteng, MPhil, research fellow; S Greenfield, MA, PhD, professor of medical sociology, College of Medical and Dental Sciences, University of Birmingham, Edgbaston. S Harrison, BSc, ClinPsyD, research officer; C Heneghan, MA, DPhil, MRCGP, professor of evidence based medicine; A Ward, PhD, director of postgraduate studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford. Address for correspondence Ian Litchfield, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, UK. E-mail: i.litchfield@bham.ac.uk Submitted: 3 November 2015; Editor’s response: 11 March 2016; final acceptance: 15 March 2016. ©British Journal of General Practice This is the full-length article (published online 7 Jun 2016) of an abridged version published in print. Cite this version as: Br J Gen Pract 2016; DOI: 10.3399/bjgp16X685693 Ian Litchfield, David Fitzmaurice, Patricia Apenteng, Sian Harrison, Carl Heneghan, Alison Ward and Sheila Greenfield Prevention of hospital-acquired thrombosis from a primary care perspective: a qualitative study 1 British Journal of General Practice, Online First 2016