Effect Of Group Visits On Hua Falin Anticoagulant Therapy In Patients With Non Valvular Atrial Fibrillation

Objective:1.Observe effect of group visits for anticoagulation knowledge of patients with valvular atrial fibrillation and warfarin anticoagulation therapy,compliance of anticoagulant therapy,anticoagulant effect,and the number of anticoagulant event.2.Observe the satisfaction degree and subjective feeling of the patients who participated in the routine nursing,the patients who participated in the group visits,and the medical staff who implemented group visits.Method:1.Experimental study of class.By convenient sampling method,114 cases of non valvular atrial fibrillation warfarin anticoagulation treated by cardiovascular medicine of the Second People's hospital of Changshu were included(Twenty-one and twenty-two ward).Random selection of twenty-one ward as 57 cases of intervention group,and twenty-two ward as 57 cases of control group.2.Group visits in intervention group.It includes establishing group visits team and training team members.Group activities in every 8~10 patients: 5 minutes of warm-up communication,25 minute health education,5 minutes' rest,20 minute question and answer interaction,5 minutes summary,last 1 hours.A monthly telephone follow-up after discharge,Including the importance of taking warfarin,precautions for taking medicine,Vitamin K1 content in newly listed green leafy vegetables,Self monitoring has no bleeding tendency,Warfarin anticoagulant monitoring record table,warfarin anticoagulant monitoring record table,time of revisit and so on.The control group carried out routine visits.3.Before discharge,To investigate the “Population sociology and disease status questionnaire of patients with atrial fibrillation” by face-to-face filling,“Warfarinanticoagulant knowledge questionnaire for patients with atrial fibrillation”,“Warfarin anticoagulant compliance questionnaire for patients with atrial fibrillation”,three months after the discharge of the hospital,Re investigation the above three questionnaires by face-to-face filling or telephone interview.And “Anticoagulant monitoring records of patients with atrial fibrillation”,comparison of the knowledge of anticoagulant knowledge in the two groups,compliance of anticoagulant therapy,the effect of anticoagulant and the occurrence of anticoagulant events.4.“Patients' satisfaction questionnaire” was used to evaluate and compare the satisfaction degree of patients in intervention group and control group,the full score of 30 points,24-30 points satisfaction,18-23 points basic satisfaction,less than 18 points are dissatisfied ? The medical staff satisfaction questionnaire was used to evaluate the satisfaction of 8 medical staff who implemented group visits,the full score is 20 points,16-20 points satisfaction,12-15 points basic satisfaction,less than 12 points are dissatisfied?Results:1.Patient general data display : Average age of 114 patients with valvular atrial fibrillation treated with warfarin anticoagulation therapy is 65.04±5.78 years old,93.8%with spouses,the degree of culture is 60.5% of the junior middle school and below,Retirement accounts for 87.7%,medical insurance in cities and towns accounted for 87.7%,smokers accounted for 26.3%,drinkers accounted for 27.2%,the course of 5 years and below accounts for 57.9%,1~2 kinds of diseases accounted for 81.6%.2.Warfarin's anticoagulation knowledge questionnaire of 2 groups of patients was divided into three grades: good,medium and bad,on ?2 Test.Results show: In control group,there was no statistical significance in knowledge of anticoagulation knowledge before discharge and 3 months after discharge(P>0.05),in the intervention group,there was a statistically significant difference in the degree of knowledge about anticoagulation between the patients before discharge and 3 months after discharge(P<0.01),three months after discharge,there was significant difference in the knowledge of anticoagulation between the intervention group and the control group(P<0.01).3.Warfarin's anticoagulation compliance questionnaire for atrial fibrillation patients was adopted.Through independent sample t test,three months after discharge,the compliance of warfarin anticoagulation in the intervention group was monitored at INR,the two dimensions of life style compliance were higher than those of the control group(P<0.05).The score of each item is monitored according to the doctor's order INR,daily intake of stable vitamin K food,the compliance of the intervention group was higher than that of the control group,differences are statistically significant(P<0.05).4.Three months after discharge,the INR value of the patients in the intervention group was 75.5%,the INR value of the control group was 68.2%,the INR value of the intervention group was higher than that of the control group,the difference between the two groups was statistically significant(P < 0.01),the INR value's unqualified rate and exceeding standard rate of the intervention group were lower than that of the control group,differences are statistically significant(P<0.05).5.During the 3 months after discharge,there was a mild bleeding event in the intervention group and the control group.6.Satisfaction survey: 1)The patient satisfaction in the intervention group was 96.5%,the patient satisfaction in the control group was 71.9%,the difference between the two groups was statistically significant(P < 0.05),2)Eight medical staff were satisfied with91.7%.Conslusions:1.Group visits improve the knowledge of warfarin anticoagulation and the compliance of anticoagulation therapy in patients with non valvular atrial fibrillation,improving the effect of anticoagulant.2.Group visits is feasible for warfarin anticoagulation therapy in patients with non valvular atrial fibrillation,it's worth further research and promotion.