关键词: 青光眼个案管理, 依从性, 靶眼压

Abstract:

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. (Ophthalmol CHN, 2019, 28: 289-293)

Key words: glaucoma case manage, compliance, target IOP