Espallargues M, Alonso J, Castilla M
Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain.
Int Ophthalmol. 1996;20(6):315-22. doi: 10.1007/BF00176884.
AIMS/BACKGROUND: Many preoperative ophthalmic and medical tests lack proven effectiveness in the evaluation of cataract surgery patients. Variation in use has been described in the USA, but little information is available for countries with different health systems. The objectives of the study were to assess variation in ophthalmologists' use of preoperative testing on cataract surgery patients and to identify ophthalmologists' characteristics associated with it.
A postal survey was made in a representative sample (response rate of 70%) of the Barcelona Medical Association of Ophthalmologists performing cataract surgery during 1993 (N = 89). The questionnaire included information about common preoperative, intraoperative and postoperative practice and sociodemographic and professional data. Appropriateness of preoperative ophthalmic tests was classified in 3 levels (indicated tests, tests with unproven benefit, and non-indicated tests) according to recommendations of the Cataract Management Guideline Panel [1] and the American Academy of Ophthalmology Preferred Practice Pattern [2].
Almost all the ophthalmologists reported performing Fundus exam plus A-scan in the preoperative evaluation of cataract surgery patients (indicated tests). Up to 20% reported performing 'frequently' or 'always' some non-indicated or unproven benefit ophthalmic tests. Additionally, an average of 7 medical tests were 'routinely' included. Private practice and cataract subspeciality were the ophthalmologists' characteristics more frequently associated with the use of inappropriate ophthalmic tests (p < 0.05).
In Barcelona, Spain, some ophthalmic tests of unproven effectiveness are frequently performed preoperatively on cataract surgery patients without ocular comorbidity. Also, a generalized utilization of several medical tests was reported. There is potential for some cost containment and more appropriate care of cataract patients without diminishing the quality of care, in a location with low surgery rates.
目的/背景：许多术前眼科和医学检查在白内障手术患者评估中缺乏已证实的有效性。在美国已描述了使用情况的差异，但对于具有不同卫生系统的国家，相关信息却很少。本研究的目的是评估眼科医生对白内障手术患者术前检查的使用差异，并确定与之相关的眼科医生特征。
对1993年在巴塞罗那医学协会中进行白内障手术的眼科医生代表性样本（回复率70%，N = 89）进行邮寄调查。问卷包括有关常见术前、术中和术后实践以及社会人口统计学和专业数据的信息。根据白内障管理指南小组[1]和美国眼科学会首选实践模式[2]的建议，将术前眼科检查的适宜性分为3个级别（指示性检查、益处未证实的检查和非指示性检查）。
几乎所有眼科医生都报告在白内障手术患者的术前评估中进行眼底检查加A超检查（指示性检查）。高达20%的医生报告“经常”或“总是”进行一些非指示性或益处未证实的眼科检查。此外，平均“常规”纳入7项医学检查。私人执业和白内障亚专业是与使用不适当眼科检查最常相关的眼科医生特征（p < 0.05）。
在西班牙巴塞罗那，对于无眼部合并症的白内障手术患者，一些有效性未证实的眼科检查常在术前频繁进行。此外，还报告了多种医学检查的普遍使用情况。在手术率较低的地区，在不降低护理质量的情况下，有控制成本和更合理护理白内障患者的潜力。
