| Background:Heart valve replacement is the fundamental method for the treatment of heart valve disease.Patients with mechanical heart valve replacement need to receive lifelong anticoagulation therapy.However,the adherence of anticoagulation therapy is not optimistic.Prior to the uneven distribution of domestic medical resources,the long-term follow-up visit of patients mainly relies on the traditional mode of anticoagulation management,and patients need to travel to the superior hospital for anticoagulation treatment.Limited by time and space,this model is impossible to meet the needs of patients.With the development of telemedicine,some scholars have applied it to the management of patients with anticoagulant therapy,and achieved good results.In recent years,telemedicine has been applied to the management of chronic diseases.It is unclear whether telemedicine can be used in basic medical institutions for patients with MHVR and whether the effect can be of the same quality as that of superior hospitals.Objective:Both the investigation and follow-up study are used to analyze the status quo of anticoagulant treatment adherence in patients received heart valve replacement with different postoperative time.We aim to identify the key factors and provide the time and intervention ideas for improving patient adherence,and explored the application effect of telemedicine in basic medical institutions.Methods:1.Investigation on the status quo of anticoagulant adherence of patients with mechanical valve replacement1.1 Patients who underwent mechanical heart valve replacement in our department from January 2011 to December 2017 were selected as the subjects for study.1.2 With face-to-face outpatient survey,telephone interview,the Anticoagulant Treatment Adherence Scale was used to assess the adherence of patients with anticoagulation therapy.1.3 The analysis of variance with Pairwise comparison chi-square trend test,univariate analysis were used for analysis.2.Study on the effect of telemedicine follow-up anticoagulation therapy in basic medical institutions2.1 Patients who underwent mechanical valve replacement and received oral warfarin anticoagulant therapy in the department of thoracic and cardiac surgery of the Affiliated Hospital of North Sichuan Medical College were selected as the study subjects.The patients who received oral anticoagulant therapy and follow-up in the basic medical institutions cooperating with "Northeast Sichuan Valvular Disease Community Database" where the basic doctors were trained by the superior hospitals were selected as the observation group.Patients who were routinely followed up and treated with anticoagulant drugs in a higher medical institution were identified as the routine group.Patients in both groups underwent a follow-up study for 6 months.2.2 The differences in anticoagulant adherence,INR detection frequency,adherence rate,incidence of thrombosis,embolism and bleeding events,and satisfaction of anticoagulant therapy compared between the two groups during the follow-up period.Result:1.Investigation on the status quo of anticoagulant adherence of patients with mechanical valve replacement1.1 The total score of anticoagulant adherence was 34.61±7.75,and 46.22% of the patients were at the medium level or below.The total score of anticoagulant adherence of patients with different postoperative time and the adherence score level of each dimension were different or not all the same(P<0.05).Patients who underwent surgery for 1 year and 2 years were of significant differences in medication adherence(P<0.05).1.2 The chi-square trend analysis showed that the score of anticoagulant adherence in patients decreasd year by year(P<0.05).1.3 There were statistically significant differences in lifestyle adherence between patients of different genders(P<0.05),and there were statistical differences in the total score of adherence,medication and re-examination adherence among patients from different places of residence(P<0.05).Multiple linear regression analysis showed that the residence was the influencing factor of the total score of adherence,and the score of medication and re-examination adherence(P<0.001),while gender was the influencing factor of the score of lifestyle adherence(P<0.05).2.Study on the effect of telemedicine follow-up anticoagulation therapy in basic medical institutions2.1 A total of 77 cases of postoperative patients meeting the established criteria were included,among which 1 case died,2 cases were excluded due to living with their children and 1 case was out of work.In fact,73 patients were included in our study,including 40 cases in the control group and 33 cases in the observation group.There were no statistically significant differences between the two groups in age,gender,residence and so on(P>0.05).2.2 After 6 months of follow-up,the total score of anticoagulant compliance between the control group and the observation group were(36.95±8.15 vs.38.67±6.12).The total score of anticoagulant adherence between the control group and the observation group showed no statistical difference(P>0.05).There were significant differences between the two groups in terms of lifestyle(P<0.05),while there were no statistically significant differences in the score of medication adherence,re-examination adherence and self-monitoring adherence(P>0.05).2.3 There were no statistically significant differences in INR detection frequency and compliance rate between the two groups(P>0.05).2.4 There were no statistically significant differences in the incidence of total anticoagulant complications,bleeding and embolism events between the two groups(P>0.05).2.5 There was no statistically significant difference in patients' satisfaction with anticoagulant treatment between the two groups(P>0.05).Conclusions:1.The anticoagulant adherence of the patients with mechanical valve replacement is generally low in the surveyed areas,especially the patients' re-examination and self-monitoring adherence.2.The anticoagulant adherence of patients with mechanical valve replacement decreased year by year,especially 1 year after surgery.3.The adherence of medication and re-examination in rural patients are poor.4.Patients have a high acceptance of telemedicine follow-up anticoagulant therapy,and the therapy is effective.Therefore,it is suggested to be popularized. |
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