个案管理模式下青光眼患者的靶眼压管理及随访依从性

Analysis of target intraocular pressure management and follow-up compliance in case management

目的了解个案管理模式下青光眼患者的靶眼压管理及随访依从性的现况,并分析随访依从性的相关影响因素。设计横断面研究。研究对象2016年4月-2017年8月进入青光眼个案管理模式的平均年龄(50.0±18.9)岁的青光眼患者202例。方法收集研究对象进入个案管理时的人口学资料、病史资料及12个月内的随访情况。根据研究对象视野平均缺损(MD)划分轻度、中度、重度青光眼。一年内患者均按设定日期的30天内进行随访定义为随访依从性较好;未在设定日期的30天内进行随访定义为随访依从性较差。靶眼压设置率为进入个案时医生进行靶眼压设置的患者的占比。靶眼压达标率为患者一年内未超过靶眼压的占比。均选取研究对象较差眼的数据进行分析。主要指标随访依从性、靶眼压设置率、靶眼压达标率。结果202例青光眼患者病程中位数34.5(23.0,56.0)个月。靶眼压的设置率为85.1%,靶眼压达标率为67%。132例(65.3%)随访依从性较好,70(34.7%)例随访依从性较差。在校正年龄、地区、病程、疾病严重程度因素后,重度青光眼(OR=8.349,95%CI=2.517-27.698)较轻度青光眼受试者的随访依从性差;年龄>40岁的患者的随访依从性较好(OR=0.433,95%CI=0.212-0.886);本地居民比非本地居民的随访依从性好(OR=0.462,95%CI=0.216-0.990)。结论个案管理模式中大部分患者靶眼压设置率、眼压达标率及随访依从性都较高,但约1/6的患者未设置靶眼压,1/3患者的靶眼压仍未达标,约1/3的患者随访依从性较差。提示需进一步加强个案管理对医生和患者的监督作用,可能更有利于改善患者的医疗结局。

Objective To determine physician adherence totarget intraocular pressure(IOP)guidelines and to assess the association between insufficient follow-up and demographic and clinical parameters incase management model.Design Cross-section study.Participants 202 glaucoma patients with an average age of 50.0±18.9 years entered in glaucoma case management model from April 2016 to August 2017.Methods The case management model implemented in 2015 at The Eye Hospital of Wenzhou Medical University.In the model,doctor set target intraocular pressure(IOP)and make a treatment plan,and the stable patients were followed up by the case manager.The demographic data,clinical history and the documentation follow-up visits within 12 months were collected.According to the mean visual field defect(MD),the severity of the disease was classified as mild,moderate and severe.Patients who did not attend follow-up within 1 month after their scheduled follow-up date were considered to have poor follow-up.The subjects were attended on time all year was defined as good follow-up.Main Outcome Measures follow-up compliance,rate of target IOP recorded,target IOP control rate.Results 202 participants were enrolled,with an average course of disease of 34.5 months.A target IOP was present for 85.1%of patients(172/202),the study visit IOP achieved the target in 67%subjects.132(65.3%)patients had good follow-up compliance,70(34.7%)patients had poor follow-up compliance.Subjects with severe(OR=8.349,95%CI=2.517-27.698)glaucomatous disease were found to have been less adherent to their recommended follow up than those patients with mild glaucomatous disease.Subjects who were older(OR=0.433,95%CI=0.212-0.886)and live closer to hospital(OR=0.462,95%CI=0.216-0.990)were found to be more adherent to follow-up recommendations.Conclusion The large majority of patients had a target IOP and achieved the target.But on nearly one sixth of patients didn’t record a target IOP,one third of visits,IOP exceeded the target,about one third of patients had poor follow up compliance indicating the need for active management in both doctors and patients.