Müller S, Ehlken C, Bauer-Steinhusen U, Lechtenfeld W, Hasanbasic Z, Agostini H, Wilke T
IPAM - Institute for Pharmacoeconomics and Medication Logistics, University of Wismar, Alter Holzhafen 19, 23966, Wismar, Germany.
Department of Ophthalmology, Universitäts-Klinikum Schleswig-Holstein, Campus Kiel, Germany.
Graefes Arch Clin Exp Ophthalmol. 2017 Nov;255(11):2237-2246. doi: 10.1007/s00417-017-3739-1. Epub 2017 Aug 4.
The aim of this study was to assess patients' views and expectations with regard to neovascular age-related macular degeneration (nAMD) and intravitreal anti-VEGF therapy (IVT).
We conducted a multicenter, non-interventional, prospective cohort study including nAMD patients treated with IVT in Germany. Patients with at least one IVT before study enrollment and aged ≥50 years were included. Three telephone interviews were conducted during a 12-month observational period. Here, patient's beliefs/expectations with regard to the nAMD disease and the IVT treatment were discussed. Only patients who completed all three phone interviews were included in the analyses. We used a two-step cluster analysis to identify patient clusters regarding specific patient attitudes towards nAMD and its treatment.
Three hundred and thirty-two patients completed all interviews (mean age of 76.4 ± 7.2 years, 59.0% women). Out of these, 57.8% acknowledged that they needed general assistance in daily life, while 77.4% stated being able to attend general medical appointments on their own. However, 64.7% needed a driver or an accompanying person to attend their IVT appointments. In addition, 3.9% of the patients were afraid of IVT side effects. Also, 87.3% and 43.1% of the patients could name their disease or the anti-VEGF drug administered, respectively. More than three-quarters of the patients (83.1%) were aware of possible consequences of nAMD by stating vision loss or blindness, but only 16.6% knew that nAMD is a chronic disease. Generally, patients were optimistic: 70.2%, 5.1% and 13.0% of them expected stable visual acuity (VA), a significant improvement or expected worsening of VA in the next year, respectively. Almost two thirds of patients who provided their therapy expectations (47.0%) anticipated fewer injections/discontinuation of IVT. We identified five patient clusters differing significantly from each other with regard to four variables: being afraid of IVT, nAMD disease awareness, optimism with regard to effectiveness of IVT, and nAMD disease and treatment knowledge.
Only a minority of patients is aware of the chronic nature of nAMD. To motivate patients to accept a life-long IVT treatment, physicians and caregivers must know that there exist different patient types with significant differences in communication needs.
本研究旨在评估患者对新生血管性年龄相关性黄斑变性（nAMD）和玻璃体内抗血管内皮生长因子治疗（IVT）的看法及期望。
我们在德国开展了一项多中心、非干预性、前瞻性队列研究，纳入接受IVT治疗的nAMD患者。纳入标准为研究入组前至少接受过一次IVT治疗且年龄≥50岁的患者。在12个月的观察期内进行了三次电话访谈。访谈中讨论了患者对nAMD疾病和IVT治疗的信念/期望。仅完成所有三次电话访谈的患者纳入分析。我们采用两步聚类分析来确定患者对nAMD及其治疗的特定态度的患者聚类。
332名患者完成了所有访谈（平均年龄76.4±7.2岁，59.0%为女性）。其中，57.8%承认他们在日常生活中需要一般帮助，而77.4%表示能够自行前往普通医疗预约。然而，64.7%的患者需要司机或陪同人员前往接受IVT治疗。此外，3.9%的患者担心IVT的副作用。另外，分别有87.3%和43.1%的患者能说出自己的疾病或所使用的抗VEGF药物。超过四分之三的患者（83.1%）通过提及视力丧失或失明意识到nAMD的可能后果，但只有16.6%知道nAMD是一种慢性疾病。总体而言，患者较为乐观：70.2%、5.1%和13.0%的患者分别预计明年视力（VA）稳定、显著改善或恶化。几乎三分之二给出治疗期望的患者（47.0%）预计注射次数减少/停止IVT治疗。我们确定了五个患者聚类，在四个变量方面彼此存在显著差异：担心IVT、nAMD疾病认知、对IVT疗效的乐观程度以及nAMD疾病和治疗知识。
只有少数患者了解nAMD的慢性性质。为激励患者接受终身IVT治疗，医生和护理人员必须知道存在不同类型的患者，他们在沟通需求上存在显著差异。
