| Objectives:In order to further explore the application of Internet tools in warfarin anticoagulation management,this study introduces a network management model based on the original outpatient management model,carries out clinical practice,and evaluates the quality of patient anticoagulation treatment,and explores the relationship between the network anticoagulation management model and traditional outpatient clinics.The difference in anticoagulation management mode is expected to enrich the warfarin anticoagulation management mode,and at the same time explore the factors that affect the quality of anticoagulation control,so as to improve the quality of anticoagulation management by pharmacists.Methods:According to the criteria for inclusion and exclusion,103 patients who had been taking warfarin for a long time and who had been treated by a top-tier cardiovascular disease hospital in Yunnan Province between January 2019 and January 2020 were selected as the research objects.The patients are grouped according to their wishes and divided into the online follow-up group and the outpatient follow-up group.The online follow-up group is conducted in a WeChat group.The patients go to the nearest hospital to test the coagulation index and report to the WeChat group.The clinical pharmacist will give the patient medication guidance based on the results;Patients in the follow-up group regularly went to the pharmacist anticoagulation clinic for follow-up.The basic information of the patients was collected,and the TTR of the quality of anticoagulation treatment was calculated for each patient.Single factor analysis and logistic multiple regression analysis were used to investigate the factors affecting the quality of anticoagulation treatment and the difference between network follow-up and outpatient follow-up.Results:The study finally included 103 patients,including 45 in the online follow-up group and 58 in the outpatient follow-up group.Univariate analysis showed that compared with low-quality anticoagulation control patients,there were significant differences in age and concomitant medication(P<0.05);logistic multiple regression analysis showed that age(B=-0.035),combined medication(B=-1.138),two factors were negatively correlated with the quality of anticoagulation(P<0.05).The comparison between the online follow-up group and the out-patient follow-up group showed that there was no significant difference in TTR compliance(P>0.05).There were significant differences in the number of interventions by pharmacists on the warfarin dose method and the number of INR monitoring(P<0.05).Conclusions:This study is based on two management modes:online follow-up and out-patient follow-up.By providing pharmacy services for patients who take warfarin for a long time,to ensure that patients receive better anticoagulation management,and at the same time enrich the connotation of clinical pharmacy practice,it is a new trend Under the situation of medical reform,the transformation of hospital pharmacy work provides a new management model.The key to improving the quality of anticoagulation treatment is to strengthen the quality management of anticoagulation for patients over 65 years of age and the standardized management of combined anticoagulation patients.The creation of an Internet anticoagulation model is in line with the current idea of combining Internet+ with the medical industry.In terms of anticoagulation management,strengthen regional multidisciplinary collaboration,standardize anticoagulation management quality control,and network follow-up mode can achieve the same anticoagulation treatment as traditional outpatient follow-up The quality is conducive to facilitate remote patients to obtain better anticoagulant pharmaceutical services.Objectives:The purpose of this study was to explore the current differences between clinician prescriptions versus recommended guidelines of oral anticoagulants for patients with atrial fibrillation and to provide directions for the improvement of anticoagulation strategies to treat patients with atrial fibrillation,by evaluating the suitability of the prescription of oral anticoagulants for patients with atrial fibrillation.Methods: According to the inclusion and exclusion criteria,460 patients diagnosed with atrial fibrillation in a tertiary hospital in Yunnan Province between July 2019 and January 2020 were selected as the research subjects.The clinical information of the patients was collected through the hospital HIS system and calculated patient CHA2DS2-VASc score,HAS-BLED score,SAMe-TT2R2 score.Suitability of the the prescribed oral anticoagulants for patients with atrial fibrillation was evaluated based on stThe Rules for Evlauating the Inappropriateness of Prescriptions”,the medicine label of the prescription,and any related antithrombotic guidenes for treating patients with AF.Results:A total of 460 patients met the criteria for inclusion.Of those,53.7%recdved appropriate prescriptions andreceived inappropriate prescriptions.Of the patients that received inappropriate descriptions,15.1% were prescribed medication without the presentation of appropriate indicators,1.3% were prescribed the inappropriate selection of medication,and 29.6% were prescribed the inappropriate dosage of medication.For patients that were prescribed medication without the presentation of appropriate indicators,2.2% presented no indication for medication and 13.3% presented with indication for medication but not specifically oral anticoagulants.For patients with inappropriate doses,15.0% of patientsprescribed low-dose dabigatran,13.0% of patients prescribed low-dose rivaroxaban,and 1.5% of patients prescribed high-dose rivaroxaban.In safety,A total of 9.6%patients had bleeding events,2.6% patients experienced embolic events.Conclusion: This study conducted a comprehensive analysis of the suitability of oral anticoagulants in patients diagnosed with atrial fibrillation.The conclusions are representative.From the data of the research results,in clinical practice,it is common for patients with AF to receive inappropriate prescriptions of oral anticoagulants.Hospitals need to further strengthen the effective management of patients with atrial fibrillation,strictly follow relevant guidelines and instructions,correctly grasp anticoagulation indications,identify low-risk and high-risk patients,dynamically assess the risk of embolism and bleeding,and select appropriate oral anticoagulation drugs.To effectively prevent stroke and improve tiie quality of life of patients. |
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