Influence of the new rural cooperative medical system on anticoagulant therapy of warfarin in atrial fibrillation patients / 中国基层医药

ABSTRACT

Objective This research was designed to reveal the influence of the new rural cooperative medical system (NRCMS) on anticoagulant therapy of warfarin in atrial fibrillation (AF) patients in Gaochun district,Nanjing city.The reasons of not attending NRCMS and the relationship between NRCMS and the reasons of not correctly anticoagulant therapy were also investigated.Methods We collected outpatients and inpatients in Gaochun district in our hospital who suffered with AF and did not attend any medical insurance except NRCMS.Patients' data of whether enrolled in NRCMS,whether anticoagulated with warfarin,whether measure international normalized ratio and then confine it in therapeutic extent and fundamental data of gender,age etc.were collected by questionnaire.Then,the data were analyzed.Results A total of 1 094 patients were included in our research of which 896(81.9％) patients were enrolled in NRCMS.198 subjects did not attend NRCMS.The most common reason was not getting the message of NRCMS,which covered 104 patients (52.5％).Among the patients without counter indications of warfarin,801 patients did not be anticoagulated,of which 637 were covered by NRCMS and 164 were not insured by NRCMS,which accounted for 71.1％ and 82.8％ of their total respectively.The difference was statistically significant (x2 =11.387,P =0.001).Similar to the nonNRCMS,the most common reason of not accepted anticoagulation in patients covered by NRCMS was taking substitutions,which was hold by 42.9％ patients.All the differences of proportions of patients had recorded reasons with and without NRCMS had no statistical significance except for the proportion of patients who hold the reason of not knowing the necessity of anticoagulation,having difficulty in daily life,and compound reasons.Among the anticoagulated patients,202 cases did not restrict INR in therapeutic range,of which 170 cases were covered by NRCMS and 32 cases were not insured by NRCMS,which accounted for 65.6％ and 94.1％ of their total respectively.The difference was statistically significant (x2 =11.385,P =0.001).The most common reason of not restricting INR in patients covered by NRCMS was did not know the necessity of restricting INR,which was hold by 40.6％ patients.The proportions of patients who did not take anticoagulation with the reason of having difficulty in daily life had statistical difference,while the difference of other reasons did not meet statistical significance.Conclusion There were many patients did not attended NRCMS.NRCMS can improve the proportion of anticoagnlation therapy with or without correct ways.However,there were many patients did not treated with anticoagulation and there were many patients did not restrict INR in therapeutic rainge.Propaganda,health education and directions of health information are needed.