| Objective The purpose of this study was to evaluate the feasibility and clinical value of telemedicine combined family management in the management of patients with atrial fibrillationMethods During the period of December 31,2018,272 patients with atrial fibrillation who met the requirements were included in the outpatient or inpatient visits.They were divided into the experimental group and the control group,the experimental group was the telemedicine combined family management group,and the control group was the routine outpatient follow-up group.Using hospital network system to improve the patient’s information,on the basis of regular treatment group patients,conventional outpatient follow-up every 3 months time,moreover through the remote Internet tools and mobile phone APP equipment,under the family members to participate in the management of the patients for 12 months,in addition to the outpatient follow-up for the month,with APP follow-up 1 times a month,and fill in the information.Patients in the control group were routinely followed up every 3 months in the outpatient department,and no other intervention was conducted except the outpatient department.At the end of the follow-up,the completion of the patient follow-up,the patient’s family participation,family satisfaction,knowledge of atrial fibrillation,lifestyle and health behavior management,medication compliance,etc.,were analyzed to study the feasibility of telemedicine combined family management model.At the same time,drug use,INR compliance rate,heart rate control,cardiac function changes,unexpected visits and the incidence of bleeding and stroke events were compared between the two groups to evaluate the clinical effect of this management method.Results During the study period,a total of 272 patients were enrolled and 19 lost,among which 3 lost in the telemedicine combined family management group(2.26%)and 16 lost in the outpatient follow-up group(11.5%).A total of 253 patients were finally counted.Baseline data there were no statistically significant differences between the two groups in age,gender,smoking and drinking history,cha2ds2-vasc score,HAS-BLED score,combined disease,cardiac function,blood routine,liver function,kidney function,mean ventricular rate,and drug use(P<0.05)After the end of the study,patients in the telemedicine combined family management group should complete 1040 APP follow-ups,with a percentage of 91.5%(952).Among the reasons for not completing the APP follow-up,59.1%(52 times)were due to the patients’forgetting to upload during the follow-up time,and 40.9%(36 times)were due to the patients’ conscious that they were in good physical condition and did not need to fill in the condition changes.The patients with good follow-up compliance accounted for 88.5%.In terms of family participation,83.8%(109 cases)of family members participated in patient management in the telemedicine combined family management group,and 52%(64 cases)of family members participated in patient management in the outpatient follow-up group,showing a statistical difference between the two groups(P<0.01).In the comparison of the two modes of patient satisfaction,there were statistical differences in the overall satisfaction,the satisfaction of diagnosis and treatment mode,the satisfaction of convenience and practicability,the satisfaction of communication and the satisfaction of drug adjustment(P<0.01).The telemedicine combined family management group was superior to the outpatient follow-up group.There was no statistical difference in efficacy satisfaction(P=0.44).In terms of the knowledge of atrial fibrillation,except the two results of the telemedicine combined family management group and the outpatient follow-up group,there was no statistical difference between the results of the telemedicine combined family management group and the outpatient follow-up group(P>0.05),the other nine results were better than the outpatient follow-up group(P<0.05).In terms of lifestyle and health behaviors,the telemedicine combined family management group was better than the outpatient follow-up group in 6 results of low-salt and low-fat diet,regular medication,self-monitoring of blood pressure,weight control,reasonable exercise and learning of atrial fibrillation knowledge(P<0.01).The proportion of patients with good medication compliance in the telemedicine combined family management group after follow-up was 91.5%,88.5%,86.2%and 83.8%in March,June,September and December,and 89.4%,74.8%,71.5%and 65%in the regular outpatient group in March,June,September and December,respectively.There was no statistically significant difference between the two groups in patients with good medication compliance at the 3rd month(P=0.87),and the difference was statistically significant at the 6th month,the 9th month and the 12th month(P<0.05).The INR compliance rates of the telemedicine combined family management group in March,June,September and December were 88.5%,86.2%,84.6%and 83.8%,respectively,and that of the regular outpatient group in March,June,September and December were 87.8%,72.4%,74.0%and 64.2%,respectively.There was no statistically significant difference in the INR compliance rate between the two groups in March(P=0.57),and there was a statistically significant difference in the INR compliance rate in March,June and December(P<0.05).The average number of unexpected visits in the telemedicine combined family management group in March,June,September and December was 1.62,1.18,0.98 and 0.97,respectively.The average number of unexpected visits in the regular outpatient group in March,June,September and December was 1.64,1.53,1.71 and 1.64,respectively.There was no statistical difference in the average number of unexpected visits between the two groups in March(P>0.05),and there was a statistical difference in the average number of unexpected visits in June,September and December(P<0.05).The incidence of bleeding in the telemedicine combined family management group and the conventional outpatient group was 3.1%and 8.9%,respectively,with statistically significant differences(P<0.05).The incidence of ischemic stroke was 0.8%and 2.4%,respectively,there was no statistical difference between the two groups(P=0.07).The left atrial diameter(mm)of the telemedicine combined family management group before and after the follow-up was 37.95 ± 4.87 and 37.47± 5.89,respectively,and the left ventricular ejection fraction(%)before and after the follow-up was 60.07 ±7.61 and 61.32 ±3.55,respectively,with no statistically significant difference(P>,0.05).The left atrial diameter(mm)of the control group before and after the follow-up was 37.13±5.82 and 38.59±5.45,respectively,and the left ventricular ejection fraction(%)before and after the follow-up was 59.73±3.48 and 59.10±3.74,respectively,with no statistically significant difference(P>,0.05).The mean ventricular rate(s/min)of the telemedicine combined family management group before and after the follow-up was 85.38 ± 12.65 and 75.38 ± 9.70,respectively,with statistically significant difference(P<0.01).The mean ventricular rate(s/min)of the control group before and after the follow-up was 86.35± 14.12-and 79.85± 10.21,respectively,with statistically significant difference(P<0.01).After follow-up,there was a significant difference in ventricular rate control between the two groups(P<0.01).Conclusion This study shows that it is feasible to apply telemedicine combined family management model to manage patients with atrial fibrillation under the background of mobile medical.This management model has a high level of family participation,which can improve the awareness rate of patients’ related chronic disease knowledge,improve their healthy behavioral ability,and improve the compliance of follow-up,which has been recognized by patients and family members.The results show that the combined family management model of telemedicine has certain effects in clinical practice,which can improve patients’ medication use,maintain a high INR compliance rate,improve patients’compliance and satisfaction,reduce unnecessary visits,improve patients’ quality of life and reduce some adverse events. |
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