社区医院中老年人群眼病快速筛查转诊实践

Practice of Rapid Screening and Referral of Eye Diseases in the Elderly in Community Hospitals

目的通过对上海四个社区中老年人志愿者眼病筛查来探索招募-筛查-转诊-回转-随访流程的可行性,为本地眼病综合防治提供方法学支撑。方法2018年8月至12月,在上海四个社区医院陆续投放眼底筛查设备,通过张贴海报、发放宣传彩页、电话招募、小区/医院微信公众号等方式招募筛查对象。共筛查6131例志愿者(合计12262眼),其中男性2416例(合计4832眼),女性3715例(合计7430眼)。通过招募-筛查-转诊-回转-随访的方式为患者提供闭环式眼部健康管理服务。结果计算各类眼病的发生数量及发生率。轻度动脉硬化763眼(6.22%)、AMD小玻璃膜疣3004眼(24.5%)、AMD中等玻璃膜疣280眼(2.28%)、大玻璃膜疣/色素沉着234眼(1.91%)、黄斑前膜832眼(6.79%)、黄斑水肿32眼(0.26%)、近视/黄斑区萎缩45眼(0.37%)、黄斑裂孔12眼(0.10%)、新生血管性黄斑病变5眼(0.04%)、其他病变10852眼(88.5%)。糖尿病相关检测:所有筛查人群中,1989人为糖尿病患者,糖尿病性视网膜病变496眼,占筛查眼数的4.04%,糖尿病性视网膜病变(轻度非增殖期)51眼(0.42%),糖尿病性视网膜病变(中重度非增殖期)437眼(3.56%),糖尿病性视网膜病变(增殖期)8眼(0.07%)。需转诊者915例,占筛查人数的14.92%。从社区招募和筛查开始,对接好三级医院做好转诊,三级医院诊治之后做好回转和随访。结论更高效地为社区居民提供眼部疾病筛查服务,并能及时转诊治疗,建立转诊体系做好闭环管理。提高患者的早期筛查早期治疗意识将疾病诊治前移,降低医疗花费,防患于未然。

Objective To explore the feasibility of recruitment-screening-referral-rotation-follow-up process through eye disease screening of middle-aged and elderly volunteers in four community hospitals in Shanghai, and to provide methodological support for local comprehensive prevention and treatment of eye diseases. Methods From August to December 2018, fundus-screening equipment was set up in four community hospitals in Shanghai. Through posters, flyers, publicity pages, telephone recruitment, community/hospital official Wechat, a total of 6131 volunteers(12262 eyes) were screened, including 2416 males(4832 eyes) and 3715 females(7430 eyes). The closed-loop eye health management service was provided for patients through recruitment-screening-referral-rotation-follow-up process. Results The number and incidence of various eye diseases were calculated. 763 eyes(6.22%) had mild arteriosclerosis, 3004 eyes(24.5%) had small drusen, 280 eyes(2.28%) had intermediate drusen, 234 eyes(1.91%) had large drusen/RPE abnormality, 832 eyes(6.79%) had epiretinal membrane, 32 eyes(0.26%) had macular edema, and 45 eyes(0.37%) had myopia/macular atrophy. There were 12 eyes(0.10%) with macular hole, 5 eyes(0.04%) with choroidal neovascularization and 10,852 eyes(88.5%) with other pathological changes. In all the screening population, 1989 were diabetic patients, 496 eyes were diabetic retinopathy, accounting for 4.04% of the screening eyes, 51 eyes(0.42%) were diabetic retinopathy(mild non-proliferative), 437 eyes(3.56%) were diabetic retinopathy(moderate to severe non-proliferative), and 8 eyes(0.07%) were diabetic retinopathy(proliferativephase). 915 cases needed to be referred, accounting for 14.92% of the screening population. The establishment of referral system started from community recruitment and screening, connected with tertiary hospitals, and completed referral after diagnosis and treatment in tertiary hospitals. Conclusion This referral mode is more efficient to provide eye disease screening services for the community residents and ensures timely referral treatment. Establishing the referral system can set up a good closed-loop management, improve the patients’ awareness of early screening and early treatment, move the disease diagnosis and treatment forward, reduce medical costs, and help patients to take preventive measures.