Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Germany.
Augenklinik, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.
Klin Monbl Augenheilkd. 2021 Nov;238(11):1220-1228. doi: 10.1055/a-1529-6726. Epub 2021 Sep 15.
To determine the effect of lockdown on medical care, with the example of ophthalmology.
Patients in a period during the first lockdown were compared to a non-lockdown period, with a total of 12 259 patients included in an observational study. Changes in different areas (elective, emergency, inpatients, surgeries) and eye care subspecialties were compared. Emergency patients were analyzed according to severity and urgency. Patients showing hints requiring treatment for urgent cardiovascular diseases were determined. Differences in patients who would have suffered severe vision loss without treatment were identified and the QALY (quality-adjusted life years) loss was determined accordingly. A model to prioritize patient visits after the end of lockdown or in future lockdown scenarios was developed. Data were collected at the University Eye Hospital LMU Munich and patient files were reviewed individually by ophthalmologists.
The average patient number decreased by - 59.4% (p < 0.001), with a significant loss in all areas (elective, emergency, inpatients, surgeries; p < 0.001). There was a decline of - 39.6% for patients at high risk/high severity. Patients with indications of a risk factor of future stroke declined significantly (p = 0.003). QALY loss at the university eye hospital was 171, which was estimated to be 3160 - 24 143 for all of Germany. Working up high losses of outpatients during these 8 weeks of projected lockdown in Germany would take 7 - 23 weeks under normal circumstances, depending on ophthalmologist density. The prioritization model can reduce morbidity by up to 78%.
There was marked loss of emergency cases and patients with chronic diseases. Making up for the losses in examinations and treatments will theoretically take weeks to months. To reduce the risk of morbidity, we recommend a prioritization model for rescheduling and future lockdown scenarios.
以眼科为例，探讨封锁对医疗的影响。
将处于首次封锁期间的患者与非封锁期间的患者进行比较，通过一项观察性研究共纳入 12259 例患者。比较了不同领域（选择性、急诊、住院患者、手术）和眼科亚专科的变化。根据严重程度和紧急程度分析急诊患者。确定了有提示需要紧急治疗心血管疾病迹象的患者。确定了没有治疗就会遭受严重视力丧失的患者之间的差异，并相应确定了 QALY（质量调整生命年）损失。制定了一种在封锁结束后或在未来封锁情况下优先安排患者就诊的模型。数据由慕尼黑 LMU 大学眼科医院收集，由眼科医生单独对患者档案进行审查。
平均患者数量减少了-59.4%（p<0.001），所有领域（选择性、急诊、住院患者、手术）均显著减少（p<0.001）。高危/高严重程度的患者数量减少了-39.6%。有未来中风风险因素的患者明显减少（p=0.003）。大学眼科医院的 QALY 损失为 171，估计德国所有地区为 3160-24143。根据眼科医生密度，在德国预计的 8 周封锁期间，对门诊患者的高损失进行研究需要 7-23 周。优先排序模型可将发病率降低高达 78%。
急诊患者和慢性病患者明显减少。理论上，弥补检查和治疗的损失需要数周到数月的时间。为了降低发病率风险，我们建议为重新安排和未来的封锁情况制定优先级模型。
