眼科执业护士主导的糖尿病视网膜病变筛查。一项为期3个月试验的结果。

Ophthalmic nurse practitioner led diabetic retinopathy screening. Results of a 3-month trial.

作者信息

Kirkwood B J, Coster D J, Essex R W

机构信息

Flinders Medical Centre, Adelaide, Australia.

出版信息

Eye (Lond). 2006 Feb;20(2):173-7. doi: 10.1038/sj.eye.6701834.

DOI:10.1038/sj.eye.6701834

PMID:16254596

Abstract

PURPOSE

To describe the design and implementation of a nurse led diabetic retinopathy screening clinic. To present the results of a 3-month trial period assessing the concordance of retinopathy grading between a nurse practitioner and an ophthalmologist.

METHOD

Patients attending for annual diabetic eye review during an initial 3-month trial period were assessed in a dedicated diabetic eye clinic by an ophthalmic nurse practitioner and an ophthalmologist, with both grading the degree of diabetic retinopathy using to the Wisconsin grading system. Each was masked as to the other's findings. The concordance of retinopathy grading between ophthalmic nurse practitioner and ophthalmologist was assessed.

RESULTS

A total of 95 patients (189 eyes) were assessed during the study period. A 92% concordance was achieved between the ophthalmologist and the ophthalmic nurse practitioner. In total, 72 eyes were graded as having some degree of retinopathy by the ophthalmologist. The sensitivity of the nurse practitioner for diagnosing the presence of diabetic retinopathy was 93%, and the specificity 91%. Nine eyes with severe nonproliferative diabetic retinopathy or worse, and four with clinically significant macular oedema were seen. All were correctly identified by the nurse practitioner.

CONCLUSIONS

The structure and management protocols of the clinic are described. An excellent concordance between ophthalmologist and nurse practitioner was achieved in this group of patients with relatively less advanced retinopathy.

摘要

目的

描述由护士主导的糖尿病视网膜病变筛查诊所的设计与实施。呈现为期3个月的试验期结果，评估执业护士与眼科医生在视网膜病变分级方面的一致性。

方法

在最初3个月的试验期内，前来进行年度糖尿病眼部检查的患者在专门的糖尿病眼科诊所由眼科执业护士和眼科医生进行评估，两人均使用威斯康星分级系统对糖尿病视网膜病变程度进行分级。彼此对对方的检查结果不知情。评估眼科执业护士与眼科医生在视网膜病变分级方面的一致性。

结果

研究期间共评估了95例患者（189只眼）。眼科医生与眼科执业护士之间的一致性达到了92%。眼科医生共将72只眼分级为有一定程度的视网膜病变。执业护士诊断糖尿病视网膜病变存在的敏感度为93%，特异度为91%。发现9只眼患有严重非增殖性糖尿病视网膜病变或更严重病变，4只眼患有具有临床意义的黄斑水肿。所有这些均被执业护士正确识别。