McDonnell P J, Nobe J, Gauderman W J, Lee P, Aiello A, Trousdale M
Doheny Eye Institute, Los Angeles, CA 90033.
Am J Ophthalmol. 1992 Nov 15;114(5):531-8. doi: 10.1016/s0002-9394(14)74479-4.
Because of increasing concern about the appropriate and cost-effective use of eye care services and procedures, several organizations have sought to arrive at practice guidelines or practice patterns from which physicians can draw guidance. To assess the potential effectiveness of such guidelines, we reviewed the care of patients with corneal ulcers. Corneal specialists recommend that cultures be obtained before initiation of treatment. We determined whether ophthalmologists implemented these guidelines by the following: (1) a review of records of 79 patients referred to a tertiary care corneal and external disease service for evaluation of keratitis, and (2) a survey by mail of practicing ophthalmologists. Antibiotic therapy without any cultures was observed in 38 of 79 referred patients with corneal ulcers (48.1%). Our survey of general ophthalmologists disclosed that 274 of 560 patients with corneal ulcers (48.7%) were treated with antibiotics without any cultures being obtained. Compliance with recommended practice in the care of corneal ulcers is poor, as measured with either method. This procedure provides insights into more effective implementation of future practice guidelines.
由于对眼科护理服务和程序的合理及成本效益使用的关注日益增加，一些组织试图制定实践指南或实践模式，以便医生从中获取指导。为了评估此类指南的潜在有效性，我们回顾了角膜溃疡患者的护理情况。角膜专家建议在开始治疗前进行培养。我们通过以下方式确定眼科医生是否执行了这些指南：（1）回顾了79例转诊至三级护理角膜和外部疾病服务机构评估角膜炎的患者记录，以及（2）对执业眼科医生进行邮件调查。在79例转诊的角膜溃疡患者中，有38例（48.1%）在未进行任何培养的情况下接受了抗生素治疗。我们对普通眼科医生的调查显示，560例角膜溃疡患者中有274例（48.7%）在未进行任何培养的情况下接受了抗生素治疗。用这两种方法衡量，在角膜溃疡护理中对推荐实践的依从性都很差。该程序为未来实践指南的更有效实施提供了见解。
