The effects of new topical treatments on management of glaucoma in Scotland: an examination of ophthalmological health care
The effects of new topical treatments on management of glaucoma in Scotland: an examination of ophthalmological health care
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新的局部治疗方法对苏格兰青光眼治疗的影响：眼科保健检查
DOI：
10.1136/bjo.86.5.551
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发表时间：
2002
影响因子：
4.1
通讯作者：
J. Forrest
中科院分区：
文献类型：
--
作者：
D. N. Bateman;R. Clark;Augusto Azuara;M. Bain;J. Forrest
背景：在过去的十年中，由于新药的引入，青光眼的治疗发生了变化。这些变化对患者的临床护理的影响进行了研究，检查手术和处方率青光眼在苏格兰的四个地理区域，1994年至1999年。研究方法：国家卫生统计数据的回顾性分析：初级保健处方数据、医院手术率、咨询人数、验光师人数和眼科检查数据，以估计的青光眼风险人群表示。结果指标为青光眼药物的处方量和成本，以及手术率，根据估计有青光眼风险的人群（PEG）、小梁切除术、整个苏格兰和四个地理“区域”（苏格兰东北部、东南部、中部和西南部）进行校正。结果：1994年至1999年，每1000名青光眼（PEG）患者的处方药增加了24.9%。这高于苏格兰处方的普遍增长（17.8%）。这一增长在所评估的四个卫生区域中各不相同（14.3%至31.9%）。局部β受体阻滞剂的处方增加很少（6.4%），但新产品（局部β受体阻滞剂、碳酸酐酶抑制剂和α2受体激动剂）的使用大幅增加，而缩瞳剂（下降47.7%）和较老的拟交感神经药的使用减少。处方模式的这一变化伴随着成本增加61.5%（4个地区范围为42.2%至73.4%）。1999年，新药占青光眼总支出的一半以上。1994年至1999年间，手术率（经PEG校正）下降了45.9%（范围为43.1%至58.6%）。其他指标表明眼科领域的活动有所增加（例如，白内障手术、眼科检查、验光师和眼科外科医生的数量都有所增加）。在苏格兰东北部，手术率下降，处方增加低于其他地区，两者都是从1994年的最低区域基线。结论：新药物类别的引入对青光眼治疗的处方产生了巨大的影响。旧的治疗方法有所减少，新的药物有所增加，这与苏格兰6年来青光眼手术率的大幅下降有关。处方和手术数据的比较表明青光眼医疗服务的地区差异。
Background: The management of glaucoma has been changed in the past decade by the introduction of new drugs. The impact of these changes on clinical care of patients was examined by examining operation and prescribing rates for glaucoma in four geographical areas of Scotland for the years 1994 to 1999. Methods: A retrospective analysis of national health statistics: primary care prescribing data, hospital derived operation rates, consultant numbers, optometrist numbers, and eye test data, expressed by estimated population at risk of glaucoma. The outcome measures were prescribing volume and cost for glaucoma medications, and operation rates, corrected for population estimated to be at risk of glaucoma (PEG), for trabeculectomy, for Scotland as a whole, and for four geographical “regions” (north east, south east, central, and south west Scotland). Results: Prescribed items per 1000 population estimated to have glaucoma (PEG) increased by 24.9% between 1994 and 1999. This was above the general increase in prescribing in Scotland (17.8%). This increase varied in the four health regions evaluated (14.3% to 31.9%). Prescribing of topical β blockers increased little (6.4%), but there was a large increase in the use of new products (topical prostaglandins, carbonic anhydrase inhibitors, and α2 agonists), at the expense of miotics (47.7% fall), and older sympathomimetics. This change in prescribing pattern was accompanied by a 61.5% increase in cost (range 42.2% to 73.4% in the four regions). New drugs accounted for more than half of total glaucoma expenditure in 1999. Operation rates (corrected for PEG) fell by 45.9% (range 43.1 to 58.6%) between 1994 and 1999. Other indicators suggested increased activity in ophthalmic areas (for example, cataract operations, eye tests, numbers of optometrists and ophthalmic surgeons all increased). Within north east Scotland operation rates decreased and prescribing increased less than in other regions, both from lowest regional baseline in 1994. Conclusions: The introduction of new drug classes has had dramatic effects on the prescribing of glaucoma treatments. There has been a decline in older treatments and an increase in new agents, which has been associated with a large reduction in operation rates for glaucoma in Scotland over 6 years. Comparison of prescribing and operation data indicates regional differences in healthcare delivery for glaucoma.