Naufal Fahd, Gajwani Prateek, Medina Robert, Dutson Madison, Mariotti Silvio P, West Sheila K
Dana Center for Preventive Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA.
World Health Organization, Geneva, Switzerland.
BMJ Open Ophthalmol. 2021 Apr 21;6(1):e000640. doi: 10.1136/bmjophth-2020-000640. eCollection 2021.
Knowledge of a patient's emotional health status and using patient-centred communication may be key to providing early intervention and referral to appropriate treatment/support services for ophthalmology patients. This study aims to determine if and how ophthalmologists use anxiety and depression scores to determine clinical care of patients with chronic eye disease.
This cross-sectional study included 10 ophthalmologists and a convenience sample of 100 of their patients (>18 years). The Patient Health Questionnaire (PHQ-9) for depression and the Generalised Anxiety Disorder (GAD-7) tool were administered to patients. Scores from these instruments were provided to ophthalmologists just prior to the clinic visit. After the visit, ophthalmologists were given a questionnaire to assess self-reported change in clinical practice and whether knowledge of scores impacted their communication style, treatment plan and follow-up protocol.
Of these patients (mean age=63), 27% reported mild-moderate anxiety or depression as their worst score, while 2% reported suicidal thoughts; 20% reported neither anxiety nor depression. Ophthalmologists' response to patients with mild or worse anxiety or depression was to change clinical approach (28%) and communication style (31%), both metrics increasing with severity of symptoms (Fisher's exact p<0.05). None reported changing their choice of treatment or modifying follow-up protocols; referral to social work/psychiatry services was 60%, 3.7% and 0% for patients with moderately severe or worse, mild-to-moderate, or minimal scores, respectively.
Providing ophthalmologists with knowledge of the emotional health of their patients may change the clinical approach and referral pattern.
了解患者的情绪健康状况并采用以患者为中心的沟通方式，可能是为眼科患者提供早期干预并转介至适当治疗/支持服务的关键。本研究旨在确定眼科医生是否以及如何使用焦虑和抑郁评分来确定慢性眼病患者的临床护理。
这项横断面研究纳入了10名眼科医生及其100名患者（年龄>18岁）的便利样本。对患者进行了用于评估抑郁的患者健康问卷（PHQ-9）和广泛性焦虑障碍（GAD-7）工具测试。在门诊就诊前，将这些工具的评分提供给眼科医生。就诊后，给眼科医生发放一份问卷，以评估他们自我报告的临床实践变化，以及评分信息是否影响了他们的沟通方式、治疗计划和随访方案。
在这些患者（平均年龄=63岁）中，27%报告其最严重程度为轻度至中度焦虑或抑郁，2%报告有自杀念头；20%报告既无焦虑也无抑郁。眼科医生对轻度或更严重焦虑或抑郁患者的反应是改变临床方法（28%）和沟通方式（31%），这两个指标均随症状严重程度增加（Fisher精确检验p<0.05）。没有人报告改变治疗选择或修改随访方案；对于中度严重或更严重、轻度至中度、或最低评分的患者，转介至社会工作/精神科服务的比例分别为60%、3.7%和0%。
向眼科医生提供其患者情绪健康的信息可能会改变临床方法和转诊模式。
