Dunn E, Black C, Alonso J, Norregaard J C, Anderson G F
Health Sciences Clinical Research Centre, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Soc Sci Med. 1997 Jun;44(11):1603-10. doi: 10.1016/s0277-9536(96)00251-1.
The patient's perspective about waiting for elective surgery is an important consideration in the management of waiting lists, yet it has received little attention to date. This study was undertaken to assess the acceptability of personal waiting times from the perspective of patients, and to examine waiting time and patient characteristics associated with the perception that a wait for cataract surgery is too long. The international prospective study was conducted in three sites with explicit waiting systems: Manitoba, Canada; Denmark; and Barcelona, Spain. Patients over the age of 50 years were recruited consecutively from ophthalmologists' practices at the time of their enlistment for first-eye cataract surgery. Anticipated waiting time, opinions about personal waiting time, and patients' visual and health characteristics were identified by means of telephone interviews. The 550 patients interviewed at the time of enlistment for surgery anticipated waits varying from < 1 to 24 months. Clinical visual acuity measures were obtained from patients' ophthalmologists/cataract surgeons. Results indicated that anticipated waiting time was the strongest predictor of patients' tolerance of waiting for cataract surgery. Patient dissatisfaction increased with the duration of the anticipated wait. Patients in all three sites were accepting of waits of three months or less, and considered waits exceeding six months to be excessive. Response to waits between three and six months varied across study sites. Patients with low tolerance for waiting had greater self-reported difficulty with vision, as assessed by a Cataract Symptom Score and expressed trouble with vision. Patients' acceptance of waiting was not associated with clinical visual acuity measures or socio-demographic characteristics. The patient perspective on acceptability of waiting times for cataract surgery suggests that restricting waiting times to less than six months and preferably less than three months and utilizing self-reported measures of visual difficulty in prioritizing patients may contribute to improved management of waiting systems. Patients are more tolerant of their personal waiting times than responses to questions about waiting for elective surgery in general would indicate, and appear to accept waiting times that are longer than those identified as reasonable by specialists.
患者对于等待择期手术的看法是等候名单管理中的一个重要考量因素，但迄今为止却很少受到关注。本研究旨在从患者角度评估个人等待时间的可接受性，并探究与认为白内障手术等待时间过长这一认知相关的等待时间及患者特征。这项国际前瞻性研究在三个设有明确等候系统的地点开展：加拿大曼尼托巴省；丹麦；以及西班牙巴塞罗那。年龄在50岁以上的患者在首次登记接受单眼白内障手术时，从眼科医生诊所中连续招募。通过电话访谈确定预期等待时间、对个人等待时间的看法以及患者的视力和健康特征。在登记手术时接受访谈的550名患者预期等待时间从不到1个月至24个月不等。临床视力测量数据来自患者的眼科医生/白内障外科医生。结果表明，预期等待时间是患者对白内障手术等待耐受性的最强预测因素。患者的不满程度随着预期等待时间的延长而增加。所有三个地点的患者都能接受三个月及以内的等待时间，并认为等待时间超过六个月过长。对于三到六个月之间的等待时间，不同研究地点的反应有所不同。通过白内障症状评分评估，等待耐受性低的患者自述视力困难更大，并表示视力有问题。患者对等待的接受程度与临床视力测量或社会人口统计学特征无关。患者对白内障手术等待时间可接受性的看法表明，将等待时间限制在六个月以内，最好是三个月以内，并在对患者进行优先排序时采用自我报告的视力困难测量方法，可能有助于改善等候系统的管理。患者对自己的个人等待时间比一般关于等待择期手术问题的回答所显示的更具耐受性，并且似乎接受比专家认为合理的等待时间更长的时间。
