新诊断的类肉瘤病患者的眼科评估：来自全民医疗保健系统的观察性研究。

Ophthalmologic assessments in patients with newly diagnosed sarcoidosis: An observational study from a universal healthcare system.

机构信息

Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.

Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.

出版信息

Respir Med. 2021 Oct;187:106575. doi: 10.1016/j.rmed.2021.106575. Epub 2021 Aug 13.

DOI:10.1016/j.rmed.2021.106575

PMID:34438352

Abstract

INTRODUCTION

Consensus guidelines for the management of sarcoidosis recommend screening eye examinations for all patients, even in those without ocular symptoms. We aimed to determine the proportion of sarcoidosis patients that complete ophthalmologic evaluations and factors associated with their performance.

METHODS

We identified patients with sarcoidosis using population health services data from Ontario, Canada between 1991 and 2019. Sarcoidosis was defined by ≥ 2 physician visits for sarcoidosis within a two-year period. Ophthalmologic evaluations were based on an optometrist or ophthalmologist visit within the year prior or two years following the diagnosis. We estimated correlations between the number of eye care professionals and proportion of sarcoidosis patients completing ophthalmologic assessments within regional health units. We evaluated for associations between ophthalmologic screening and patient characteristics using multivariable logistic regression.

RESULTS

We identified 21,679 patients with sarcoidosis in Ontario. An ophthalmologic evaluation was performed in 14,751 (68.0%), with a similar number of individuals seeing ophthalmologists and optometrists (43.7% vs. 42.2%). The percentage of sarcoidosis patients undergoing an ophthalmologic evaluation within corresponding regional health units was moderately correlated with the number of practicing ophthalmologists (r = 0.64, p = 0.01), but not the number of optometrists (r = 0.08, p = 0.77). Patients who were older [OR per year 1.02 (95% CI 1.01-1.02), p < 0.001] and female [OR 1.54 (95% CI 1.44-1.63), p < 0.001] were more likely to complete ophthalmologic evaluations. Immigrants to Canada were less likely to undergo ophthalmologic assessments [OR 0.66 (95% CI 0.60-0.73), p < 0.001].

CONCLUSIONS

Most patients with sarcoidosis complete ophthalmologic examinations, though a substantial proportion does not. Young adults, men and immigrants were less likely to complete ophthalmologic evaluations. Limited access to ophthalmologists may at least in part explain why some sarcoidosis patients fail to complete ophthalmologic screening.

摘要

简介

针对结节病管理的共识指南建议对所有患者进行眼部检查，即使是无症状患者。我们旨在确定完成眼科评估的结节病患者比例以及与他们表现相关的因素。

方法

我们使用加拿大安大略省的人群健康服务数据，从 1991 年至 2019 年确定了患有结节病的患者。结节病是通过在两年内至少有两次医生就诊来定义的。眼科评估是基于在诊断前一年或诊断后两年内由验光师或眼科医生进行的就诊。我们估计了区域卫生单位中眼科保健专业人员数量与完成眼科评估的结节病患者比例之间的相关性。我们使用多变量逻辑回归评估了眼科筛查与患者特征之间的关联。

结果

我们在安大略省确定了 21679 名结节病患者。进行了眼科评估的有 14751 名（68.0%），其中相当数量的患者看了眼科医生和验光师（43.7%比 42.2%）。相应区域卫生单位内进行眼科评估的结节病患者比例与执业眼科医生数量呈中度相关（r=0.64，p=0.01），但与验光师数量无关（r=0.08，p=0.77）。年龄较大的患者[每年的 OR 为 1.02（95%CI 1.01-1.02），p<0.001]和女性[OR 为 1.54（95%CI 1.44-1.63），p<0.001]更有可能完成眼科评估。移民到加拿大的患者接受眼科评估的可能性较小[OR 为 0.66（95%CI 0.60-0.73），p<0.001]。