Mordue A, Parkin D W, Baxter C, Fawcett G, Stewart M
Borders Health Board, Melrose, Roxburghshire.
J Public Health Med. 1994 Dec;16(4):393-8. doi: 10.1093/oxfordjournals.pubmed.a043019.
The aim of the study was to identify the criteria used by ophthalmologists when assessing patients who may require cataract surgery, examine the extent of variation in their application and explore their relationship with current patterns of supply and demand.
This was a descriptive study involving semi-structured interviews with ophthalmologists, examination of hospital clinical records, and analysis of routinely available data on waiting times and hospital activity. The setting was ophthalmology units within the Northern Region of England. The subjects were 27 consultant ophthalmologists and 160 patients undergoing cataract extraction.
There was agreement amongst ophthalmologists on the criteria used to select patients for treatment, and on the visual acuity level at which they would usually recommend surgery. All assess the degree of handicap resulting from cataract; most consider this more important than visual acuity. Over half of the patients were over 75 years old; two-thirds were women. Median visual acuity at listing was 6/36, but over 40 per cent were 6/60 or worse. Visual acuity at treatment was not recorded for 32 per cent of patients. Wide variation in visual acuity at listing existed between both units and consultants, and for both the affected and other eye. Second extractions may be performed at a better level of visual acuity than for first extractions. Median visual acuity at listing was significantly correlated with total waiting times for individual consultants. Lower cataract extraction rates are associated with long waiting times and poorer visual acuity at listing.
There is considerable unmet need for cataract treatment within the Northern Region and significant variation in the current meeting of needs and demands. It may be that more needs could be met simply by changing referral and treatment patterns without increasing total service activity. Although visual acuity is a reasonably objective measure in routine use, the level of visual handicap is more important, and its assessment is more subjective; development of a standard method to assess this could help in producing guidelines for patient referral and selection. Audit of treatment thresholds could allow a better matching of service provision to population needs.
本研究旨在确定眼科医生在评估可能需要白内障手术的患者时所使用的标准，检查这些标准应用中的差异程度，并探讨它们与当前供需模式的关系。
这是一项描述性研究，包括对眼科医生进行半结构化访谈、检查医院临床记录以及分析关于等待时间和医院活动的常规可用数据。研究地点为英格兰北部地区的眼科科室。研究对象为27名眼科顾问医生和160名接受白内障摘除术的患者。
眼科医生在选择治疗患者的标准以及通常会推荐手术的视力水平上达成了一致。所有人都评估白内障导致的残疾程度；大多数人认为这比视力更重要。超过一半的患者年龄在75岁以上；三分之二为女性。列入手术名单时的中位视力为6/36，但超过40%的患者为6/60或更差。32%的患者在治疗时未记录视力。在不同科室和顾问医生之间，以及患眼和另一只眼之间，列入手术名单时的视力存在很大差异。二次摘除手术时的视力可能比首次摘除时更好。列入手术名单时的中位视力与个别顾问医生的总等待时间显著相关。较低的白内障摘除率与较长的等待时间以及列入手术名单时较差的视力相关。
英格兰北部地区对白内障治疗存在大量未满足的需求，当前在满足需求方面存在显著差异。可能只需改变转诊和治疗模式就能满足更多需求，而无需增加总服务量。虽然视力在常规使用中是一个相对客观的指标，但视觉残疾程度更重要，且其评估更主观；开发一种评估此指标的标准方法有助于制定患者转诊和选择指南。对治疗阈值进行审核可以使服务提供更好地匹配人群需求。
