Bateman D N, Clark R, Azuara-Blanco A, Bain M, Forrest J
Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, Scotland.
Br J Ophthalmol. 2002 May;86(5):551-4. doi: 10.1136/bjo.86.5.551.
The management of glaucoma has been changed in the past decade by the introduction of new drugs. The impact of these changes on clinical care of patients was examined by examining operation and prescribing rates for glaucoma in four geographical areas of Scotland for the years 1994 to 1999.
A retrospective analysis of national health statistics: primary care prescribing data, hospital derived operation rates, consultant numbers, optometrist numbers, and eye test data, expressed by estimated population at risk of glaucoma. The outcome measures were prescribing volume and cost for glaucoma medications, and operation rates, corrected for population estimated to be at risk of glaucoma (PEG), for trabeculectomy, for Scotland as a whole, and for four geographical "regions" (north east, south east, central, and south west Scotland).
Prescribed items per 1000 population estimated to have glaucoma (PEG) increased by 24.9% between 1994 and 1999. This was above the general increase in prescribing in Scotland (17.8%). This increase varied in the four health regions evaluated (14.3% to 31.9%). Prescribing of topical beta blockers increased little (6.4%), but there was a large increase in the use of new products (topical prostaglandins, carbonic anhydrase inhibitors, and alpha(2) agonists), at the expense of miotics (47.7% fall), and older sympathomimetics. This change in prescribing pattern was accompanied by a 61.5% increase in cost (range 42.2% to 73.4% in the four regions). New drugs accounted for more than half of total glaucoma expenditure in 1999. Operation rates (corrected for PEG) fell by 45.9% (range 43.1 to 58.6%) between 1994 and 1999. Other indicators suggested increased activity in ophthalmic areas (for example, cataract operations, eye tests, numbers of optometrists and ophthalmic surgeons all increased). Within north east Scotland operation rates decreased and prescribing increased less than in other regions, both from lowest regional baseline in 1994.
The introduction of new drug classes has had dramatic effects on the prescribing of glaucoma treatments. There has been a decline in older treatments and an increase in new agents, which has been associated with a large reduction in operation rates for glaucoma in Scotland over 6 years. Comparison of prescribing and operation data indicates regional differences in healthcare delivery for glaucoma.
在过去十年中，新型药物的引入改变了青光眼的治疗方式。通过研究1994年至1999年苏格兰四个地理区域青光眼的手术率和处方率，考察了这些变化对患者临床护理的影响。
对国家卫生统计数据进行回顾性分析：初级保健处方数据、医院得出的手术率、顾问数量、验光师数量和视力测试数据，以估计有患青光眼风险的人群表示。结果指标为青光眼药物的处方量和成本，以及针对小梁切除术、整个苏格兰以及四个地理“区域”（苏格兰东北部、东南部、中部和西南部）的手术率，经估计有患青光眼风险的人群（PEG）校正。
1994年至1999年间，每1000名估计患有青光眼的人群（PEG）的处方量增加了24.9%。这高于苏格兰处方量的总体增长（17.8%）。在评估的四个卫生区域中，这种增长有所不同（14.3%至31.9%）。局部β受体阻滞剂的处方量增加不多（6.4%），但新产品（局部前列腺素、碳酸酐酶抑制剂和α₂激动剂）的使用大幅增加，同时缩瞳剂（下降47.7%）和较老的拟交感神经药的使用减少。这种处方模式的变化伴随着成本增加61.5%（四个区域的范围为42.2%至73.4%）。1999年，新药占青光眼总支出的一半以上。1994年至1999年间，手术率（经PEG校正）下降了45.9%（范围为43.1%至58.6%）。其他指标表明眼科领域的活动有所增加（例如，白内障手术、视力测试、验光师和眼科外科医生的数量均增加）。在苏格兰东北部，手术率下降，处方量的增加低于其他地区，两者均从1994年的最低区域基线开始。
新型药物类别的引入对青光眼治疗的处方产生了巨大影响。旧的治疗方法减少，新药物增加，这与苏格兰青光眼手术率在6年内大幅下降有关。处方和手术数据的比较表明青光眼医疗服务存在区域差异。
