Suchergebnisse

Проаналізували нормативну базу і опитали 515 хворих на первинну глаукому. Виявлено недостатнє охоплення населення офтальмологічним скринінгом, що достовірно посилює шанси пізньої діагностики (ОЯ=2,56; 95%СІ: 1,55-4,23). Практично 100% охоплення хворих диспансерним спостереженням ліка-рями-офтальмологами супроводжувалось суттєвим зниженням його якості з віком пацієнтів (у 1,5-3 рази після 75 років). Пропонується опрацювати на законодавчому рівні механізми активізації компетенцій лікарів загальної практики/сімейних лікарів щодо охоплення населення скринінгами, контролю та організації виконання рекомендацій лікарів-спеціалістів.Проанализировали нормативную базу и опросили 515 больных первичной глаукомой. Выявлен недостаточный охват населения офтальмологическим скринингом, достоверно усиливающий шансы поздней диагностики (ОЯ=2,56; 95%СІ: 1,55-4,23). Почти 100% охват больных диспансерным наблюдением врачами-окулистами сопровождался существенным снижением его качества с возрастом пациентов (в 1,5-3 раза после 75 лет). Рекомендуется на законодательном уровне отработать механизмы активизации компетенций врачей общей практики по охвату населения скринингами, контролю и организации выполнения рекомендаций врачей-специалистов.Purpose of the study was to analyze a role and capabilities of general practitioner/family physician on early detection and follow-up care patients with primary glaucoma. There were studied the legal framework of ophthalmology service organization in Ukraine and functions of general practitioner/family physician in it. The completeness of implementation of medical technologies was estimated from data of questionnaires of patients about given to them diagnostic and curative services for the last three years. The study was conducted at the ophthalmic departments of three District Hospitals in Ivano-Frankivsk region. A representative group of 515 persons has been surveyed grouped per severity of glaucomatous damage into two main groups: 347 patients with I-II (initial) stages of primary glaucoma and 168 patients with III-IV (late) stages of the disease. There were established the significant shortcomings in realization of the mass screening on glaucoma. Thus, in the absolute majority of respondents (71. 0±2. 0%), irrespective of gender and place of residence (р>0. 05), the diagnosis of primary glaucoma was established after visit to the doctor-oculist and only 16. 0±1.6% cases was detected during medical check-up, and 13. 1±1.5% cases of glaucoma was discovered accidentally at the out-patient or in-patient treatment concerning other disease. Moreover, the rate of active detection of disease progressively decreased with patients' age (р<0. 05). If in working age (under 60 years) practically in every fourth (23. 4±5. 3%) surveyed the disease was detected during the medical examinations, in the age group over 80 years only 5. 7±2. 5%. In spite of this, with age there was increased the rate of glaucoma cases detected at the patients visits to the oculist (from 68. 8±5. 8% to 73. 9±4. 7% respectively), or at the in-patient treatment of other disease (from 3. 1±2. 2% to 12. 5±3. 5%). It is well-proven that periodic medical check-ups ignoring increases the chances of the late detection of glaucoma (OR=2. 56; 95%CI: 1. 55-4. 23). Glaucoma as a chronic disease, according to Ukrainian legislation, requires follow-up monitoring by the doctor-ophthalmologist throughout life. The survey results showed that follow-up cares for patients with glaucoma are performed sufficiently on a quantitative level. The vast majority (98. 6 ± 0. 5%) of the respondents, regardless of stage of the disease, location and gender, indicated that they are on the medical monitoring by the ophthalmologists. However, analysis of the quality of clinical examination of patients with glaucoma, particularly in terms of coverage required diagnostic methods showed a lack of performance: visual acuity during the last three years was determined only 79. 6±1. 9% of respondents, the visual field 79. 0±2. 0%, intraocular pressure 79. 2±2. 0%, examination the optic nerve head 78. 8±2. 0%. Thus, the reporting rate is formed due the rapid decrease coverage surveys of patients with the onset of old age: almost 1. 5 times up to 67. 0-68. 8% in the 75-79 years and almost three times up to 32. 6 ± 7. 3% over the age of 80 years (p<0. 001). In our opinion, this is most likely due to the reduced capabilities of older people attending physician ophthalmologist. There was recommended to work in law boosting competence of general practitioner/family physician on coverage of screening, monitoring implementation of the recommendations of medical professionals.