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“无论全科医生说什么,我都会照做”——一项关于2型糖尿病患者获得初级眼科护理观点的定性研究

'Whatever the GP says, is what I'll do'-A qualitative study of patient perspectives in accessing primary eye care for type 2 diabetes.

作者信息

Huang-Lung Jessie, Rai Akshay, Duong Annita, Balakrishnan Apirami, Khan Abdullah, Husudo Jeremy, Gyawali Rajendra, Nazarian Joseph, Ford Belinda, Rhee Joel, Jalbert Isabelle, Keay Lisa

机构信息

School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia.

The George Institute for Global Health, Sydney, New South Wales, Australia.

出版信息

Ophthalmic Physiol Opt. 2025 Jan;45(1):67-76. doi: 10.1111/opo.13398. Epub 2024 Oct 4.

DOI:10.1111/opo.13398
PMID:39365256
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11629847/
Abstract

INTRODUCTION

To investigate the perspectives of people accessing a general medical practitioner (GP)-optometry model of collaborative care that was established to increase access to diabetes eye care.

METHODS

Qualitative study of patient barriers and facilitators to accessing primary diabetes eye care located in a metropolitan area in Australia. One-on-one interviews were recorded, transcribed and thematically analysed using a determinant framework on patient-centred access to health care.

RESULTS

Twenty-four people with type 2 diabetes, including 15 males and 9 females, who accessed the service between September 2021 and June 2022 agreed to participate. Mean (SD) age of the participants was 52 (12) years and 50% had been diagnosed with diabetes for <2 years. Facilitators to accessing diabetes eye care included a referral from a GP or GP nurse, fee-free consultations, availability of after-hours appointments and short waiting times. Barriers to access included perceived out-of-pocket costs, competing responsibilities and lack of awareness of diabetic retinopathy screening recommendations.

CONCLUSION

Considering diabetic retinopathy may present asymptomatically, primary health practitioners (optometrists and GPs) are well positioned to raise patient awareness of the importance of routine eye examinations. In Australia, access to routine screening could be facilitated by fee-free eye checks and personalised text message reminders implemented at a health system level.

摘要

引言

调查采用全科医生 - 验光师协作护理模式的人群的观点,该模式旨在增加糖尿病眼部护理的可及性。

方法

对澳大利亚一个大都市地区患者获取原发性糖尿病眼部护理的障碍和促进因素进行定性研究。采用以患者为中心的医疗保健获取的决定因素框架,对一对一访谈进行记录、转录和主题分析。

结果

2021年9月至2022年6月期间接受该服务的24名2型糖尿病患者同意参与,其中包括15名男性和9名女性。参与者的平均(标准差)年龄为52(12)岁,50%的患者被诊断患有糖尿病的时间<2年。获取糖尿病眼部护理的促进因素包括全科医生或全科护士的转诊、免费咨询、提供非工作时间预约以及等待时间短。获取障碍包括感知到的自付费用、相互竞争的责任以及对糖尿病视网膜病变筛查建议缺乏认识。

结论

考虑到糖尿病视网膜病变可能无症状出现,初级卫生保健从业者(验光师和全科医生)有能力提高患者对常规眼部检查重要性的认识。在澳大利亚,通过在卫生系统层面实施免费眼部检查和个性化短信提醒,可以促进常规筛查的可及性。

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本文引用的文献

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Public Health Res Pract. 2024 Jun 19;34(2):3422415. doi: 10.17061/phrp3422415.
2
Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services.即时护理点糖尿病视网膜病变筛查(DR SPOC):通过在现有服务中整合便携式技术,检测未确诊和威胁视力的视网膜病变。
BMJ Open Diabetes Res Care. 2023 Aug;11(4). doi: 10.1136/bmjdrc-2023-003376.
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Barriers and facilitators to diabetic retinopathy screening within Australian primary care.澳大利亚初级保健中糖尿病视网膜病变筛查的障碍和促进因素。
BMC Fam Pract. 2021 Nov 30;22(1):239. doi: 10.1186/s12875-021-01586-7.
4
Barriers and enablers to diabetic eye screening attendance: An interview study with young adults with type 1 diabetes.糖尿病眼病筛查参与的障碍和促进因素:一项对 1 型糖尿病青年的访谈研究。
Diabet Med. 2022 Mar;39(3):e14751. doi: 10.1111/dme.14751. Epub 2021 Dec 29.
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Experiences of Patients With Diabetes Attending a Publicly Funded Eye Care Pathway in Western Sydney: A Qualitative Study.西悉尼地区参加公共资助眼科护理途径的糖尿病患者的经历:一项定性研究。
J Patient Exp. 2021 Oct 20;8:23743735211049652. doi: 10.1177/23743735211049652. eCollection 2021.
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Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review.促进高收入国家少数民族群体获得眼科保健服务的干预措施:范围综述。
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