我国原发性青光眼诊断和治疗专家共识遵循情况的调查

A survey on the compliance ofthe expert consensus in the diagnosis and treatment of primary glaucoma in China

目的了解眼科医师遵循我国原发性青光眼诊断和治疗专家共识的现状,评估在面授指导和网络教育后对其知晓度及依从性的效果。方法采用横断面非随机抽样调查法,收集2018年10月至2019年8月填答我国原发性青光眼诊断和治疗专家共识问卷调查的临床眼科从业医师的数据,通过面授指导、网络直播和视频回放的方式进行专家共识的系列培训,培训前后通过微信两次发送问卷调查,比较参加培训和未参加培训医师对其知晓度和依从率的差异。采用卡方检验对计数资料进行组间比较,采用秩和检验对等级资料进行组间比较。采用因子分析对问卷的结构效度进行分析;采用最大方差法对因子进行旋转;采用Kaiser-Meyer-Olkin和Bartlett检验对数据结构进行检验。结果第一次调查收到715份问卷,第二次调查收到515份问卷。正高级职称的医师和青光眼专科医师培训参与率更高(χ^2=11.54,59.114;P<0.05)。第一次调查共识依从率为7.55%~85.59%,在51.75%~85.59%之间居多。正常性青光眼、高眼压症的排他性诊断、原发性闭角型青光眼激发试验阴性的意义等基本概念知晓率较高(83.36%~85.59%)。依从率最低的是Goldman压平眼压计的使用(7.55%),其次是采用改良的PACG激发试验(14.45%~28.20%),对青光眼性视神经损害的ISNT原则正确理解率也较低(40.42%)。培训后再次问卷调查,未接受培训者总体依从率在17.38%~82.62%,接受培训者总体依从率在20.47%~96.34%。其中,房角镜宽窄分级的判断、青光眼性视神经损害和盘沿下方>上方>鼻侧>颞侧原则(ISNT原则)的理解、视野的判读、以及原发性闭角型青光眼的分类方法、正常眼压性青光眼的定义及高眼压症治疗时机等,接受培训者的知晓度较未接受培训的均提高至11%~26%,且有统计学意义(χ^2=5.687~31.568, P<0.05)。结论目前我国原发性青光眼诊断和治疗专家共识的知晓度及依从率有待提高,通过面授指导联合网络培训的方式,可有效提高知晓度和依从率。若通过强制性培训、建立青光眼专家与非青光眼专家的团队协作等方式,将有助于推动专家共识和指南在临床工作中的实施。

Objective This study was aim to obtain the current situation of ophthalmologists following the expert consensus in the diagnosis and treatment of primary glaucoma in China, and evaluate the effect of improving the compliance of expert consensus by live lectures and webcast training. MethodsCross-section non-random sampling network WeChat questionnaires were used in the survey. From October 2018 to August 2019, questionnaires designed according to the expert consensus of the diagnosis and treatment of primary glaucoma in China were collected from ophthalmologists. The glaucoma expert consensus training was carried out through live lectures, live broadcast and video playback. Two questionnaires were sent through WeChat before and after the training. The differences of consensus awareness and compliance rate were compared the groups who participated in the training or not. Chi-square test was used to compare the counting data between groups, and rank sum test was used to compare the ranking data between groups. Factor analysis was used to analyze the structural validity of the questionnaire, and maximum variance method was used to rotate factors. Kaiser-Meyer-Olkin (KMO) and Bartlett tests. Results715 questionnaires were received during the first survey and 515 questionnaires were received during the second survey after the training. The training rate of doctors with senior titles and glaucoma specialists was higher than that of the other ophthalmologists (χ^2=11.541, 59.114;P<0.05). The consensus compliance rates during the first survey were 7.55% to 85.59%, and majority of them were 51.75% to 85.59%. The awareness rates of basic concepts such as normal tension glaucoma (NTG), exclusive diagnosis of ocular hypertension and negative significance of primary angle closure glaucoma (PACG) provocative test were higher (83.36% to 85.59%). The lowest compliance rate was the use of Goldmann tonometer (7.55%), followed by the modified PACG provocative test (14.45% to 28.20%). The correct understanding rate of inferior superior nasal temporal (ISNT) principle for glaucoma optic nerve damage was also low (40.42%). During the second survey after the training, the compliance rate was 17.38% to 82.62% in the group who did not attend the training, besides the overall compliance rate was 20.47% to 96.34% in the group who did. Among them, the compliance rate of those who received training was significantly higher than that of who did not, and the increase was between 11% and 26% with statistical difference in the judgment of the width and narrow grade of gonioscopy, the understanding of glaucoma optic nerve damage and ISNT principle, the interpretation of visual field, the classification of PACG, the definition of NTG, when to treat ocular hypertension, etc(χ^2=5.687-31.568, P<0.05). ConclusionIn current, the compliance of expert consensus on diagnosis and treatment of primary glaucoma in China needs to be improved. Live lectures and wechast training could effectively improve the cognition and compliance of expert consensus. It is necessary to promote the compliance of expert consensus and guidelines in clinical practice through mandatory training and teamwork between glaucoma experts and ophthalmologists.