Friedman David S, Nordstrom Beth, Mozaffari Essy, Quigley Harry A
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Ophthalmology. 2005 Sep;112(9):1500-4. doi: 10.1016/j.ophtha.2005.02.030.
To determine the management patterns for glaucoma and suspect glaucoma in a nationally representative sample of newly treated persons.
Retrospective cohort study of persons enrolled in a large managed care organization.
One thousand seven hundred twelve diagnosed suspects and 3623 diagnosed glaucoma patients.
Linked pharmacy and patient care data were used to examine the glaucoma management and treatment patterns in this cohort of persons insured by a single managed care organization. Rates of monitoring and treatment were calculated for the 3 study groups.
Probability of monitoring (return visits, visual fields [VFs], and optic nerve head imaging or photography) and treatment (argon laser trabeculoplasty [ALT] and surgery) for newly treated persons with suspect and glaucoma diagnoses.
After a median follow-up of 440 days, 83% of treated diagnosed suspects had had a billed follow-up office visit to either an optometrist or an ophthalmologist at any time during follow-up, 46% had had at least one billed VF, and 13% had had some form of optic nerve head imaging. Rates were slightly higher for those with diagnosed glaucoma (P>0.05). Surgery and ALT were performed rarely in this treated population (1%-6% at 2 years).
This study suggests that a large proportion of individuals felt to require treatment for glaucoma or suspect glaucoma are falling out of care and are being monitored at rates lower than expected from recommendations of published guidelines. More research is needed to confirm these findings and to determine the reasons for loss to follow-up and low monitoring rates.
在具有全国代表性的新接受治疗的人群样本中确定青光眼和疑似青光眼的管理模式。
对加入大型管理式医疗组织的人群进行回顾性队列研究。
1712名确诊的疑似患者和3623名确诊的青光眼患者。
利用药房与患者护理数据的关联，研究由单一管理式医疗组织承保的这一队列人群中的青光眼管理和治疗模式。计算3个研究组的监测和治疗率。
确诊为疑似青光眼和青光眼的新接受治疗者的监测（复诊、视野检查[VF]以及视神经乳头成像或摄影）和治疗（氩激光小梁成形术[ALT]和手术）概率。
在中位随访440天后，83%接受治疗的确诊疑似患者在随访期间的任何时候都曾因复诊而向验光师或眼科医生付费，46%至少进行过一次付费视野检查，13%进行过某种形式的视神经乳头成像。确诊青光眼患者的这些比率略高（P>0.05）。在该接受治疗的人群中，手术和ALT很少进行（2年时为1%-6%）。
本研究表明，很大一部分被认为需要治疗青光眼或疑似青光眼的个体未得到持续护理，其监测率低于已发表指南建议的预期。需要更多研究来证实这些发现，并确定失访原因和低监测率的原因。
