Use of gonioscopy in Medicare beneficiaries before glaucoma surgery
Use of gonioscopy in Medicare beneficiaries before glaucoma surgery
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DOI：
10.1097/01.ijg.0000212287.62798.8f
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发表时间：
2006-12-01
影响因子：
2
通讯作者：
Evans, Stacy J.
中科院分区：
文献类型：
--
作者：
Coleman, Anne L.;Yu, Fei;Evans, Stacy J.
目的：美国眼科学会针对闭角型和开角型青光眼 (OAG) 患者的首选实践模式建议在初次就诊时进行双侧房角镜检查，以评估窄角型或闭角型青光眼 (ACG) 的可能性，然后至少每 5 年重复一次检查。本研究旨在评估在 Medicare 人群中，眼科护理人员在 OAG、解剖窄角和 ACG 计划青光眼手术前进行房角镜检查的频率。 方法：对 1999 年在美国接受青光眼手术的 Medicare 受益人的 5% 随机样本中获得的数据进行回顾性审查。确定了 1995 年至 1999 年期间在青光眼手术前至少进行过一次房角镜检查的患者比例。还检查了可能影响进行房角镜检查决定的人口和临床因素。结果：总体而言，49% 的医疗保险受益人在青光眼手术前 4 至 5 年期间进行了房角镜检查。与解剖性窄角 (58%) 和 ACG (57%) 患者相比，OAG 患者 (46%) 的这一比率显着较低 (P < 0.001)。西班牙裔、老年人（70 至 84 岁）、接受激光虹膜切开术的患者以及在纽约/新泽西地区接受护理的患者的术前表观房角镜检查率均显着较高（P < 0.05）。 结论：鉴于目前的建议，医疗保险受益人青光眼手术前的房角镜检查未得到充分利用、编码不足和/或编码错误。使用不足是接受激光虹膜切开术的患者特别关注的问题，因为它是 ACG 中选择的诊断测试。
Purpose: The American Academy of Ophthalmology Preferred Practice Patterns for angle closure and open-angle glaucoma (OAG) patients recommends performing bilateral gonioscopy upon initial presentation to evaluate the possibility of narrow angle or angle-closure glaucoma (ACG) and then repeating the examination at least every 5 years. This study aims to assess how commonly eye care providers perform gonioscopy before planned glaucoma surgery in OAG, anatomic narrow angle, and ACG in the Medicare population.Methods: Data obtained from a 5% random sample of Medicare beneficiaries undergoing glaucoma surgery in the United States in 1999 were retrospectively reviewed. The proportion of patients with evidence of at least one gonioscopic examination before glaucoma surgery was determined for the period of 1995 to 1999. Demographic and clinical factors potentially influencing the decision to perform gonioscopy were also examined.Results: Overall, gonioscopy is apparently performed in 49% of Medicare beneficiaries during the 4 to 5 years preceding glaucoma surgery. This rate was significantly lower (P < 0.001) in patients with OAG (46%), as compared with anatomic narrow angle (58%) and ACG (57%) patients. Hispanics, elderly (aged 70 to 84), patients undergoing laser iridotomy, and patients receiving care in the New York/New Jersey area all had significantly higher apparent preoperative gonioscopy rates (P < 0.05).Conclusions: Gonioscopy examination before glaucoma surgery in Medicare beneficiaries is underused, undercoded, and/or miscoded, given current recommendations. Underuse is of particular concern in patients undergoing laser iridotomy as it is the diagnostic test of choice in ACG.