Analyse des Versorgungsmodells „Portal“ – Untersuchung der Ergebnisqualität der IVOM-Therapie im Hinblick auf Latenzzeiten bei exsudativer AMD

Zusammenfassung

Hintergrund Die intravitreale operative Medikamenteneingabe (IVOM) stellte gegenwärtig bei vielen Makulopathien eine logistische Herausforderung für Patient und Arzt dar. Während die Patienten die Fahrten zu den Arztbesuchen organisieren müssen, haben die medizinischen Einrichtungen ausreichend kurzfristige Ressourcen vorzuhalten, um eine zeitnahe und termingerechte Behandlung zu gewährleisten. Ziel dieser Studie ist die Evaluation der kooperativen IVOM-Therapie bei Patienten mit einer exsudativen AMD hinsichtlich der folgenden 4 Qualitätsindikatoren: a) der Latenzzeiten innerhalb des Behandlungs- und Kontrollzyklus, b) die Behandlungsfrequenzen, c) die Adhärenz und d) das medizinische Ergebnis.

Patienten und Methode In Zusammenarbeit vieler Augenärzte werden seit über 7 Jahren AMD-Patienten innerhalb eines Portalsystems kooperativ behandelt. Dabei werden zwischen der konventionell behandelnden Praxis und dem operativen Zentrum die für die Behandlung wesentlichen Daten ausgetauscht. Insgesamt wurden von 1850 Patienten insgesamt 2283 wegen AMD zu behandelnde Augen dokumentiert. Diese elektronische Dokumentation wurde hinsichtlich der o. g. Qualitätsindikatoren retrospektiv ausgewertet.

Ergebnisse Die Auswertung ergab eine durchschnittliche Latenzzeit zwischen der Kontrolle beim konservativen Augenarzt und einem erneuten Start einer IVOM-Serie von 8,1 Werktagen. Innerhalb der ersten beiden Behandlungsjahre wurden durchschnittlich 10,5 Injektionen und 8,2 Kontrolltermine pro Fall erreicht. Dabei waren nach den 2 Jahren noch 72,9% der Fälle in Behandlung bzw. Beobachtung und es konnte eine Stabilisierung des Visusgewinns von durchschnittlich 0,05 logMAR erreicht werden.

Schlussfolgerung Gerade bei der exsudativen AMD ist eine konsequente Therapie über Jahre von essenzieller Bedeutung für ein funktionelle Stabilität und Verbesserung der Sehleistung. Die Analyse des Versorgungsmodells zeigt, dass eine kooperative Organisation der IVOM-Therapie und Verlaufsdiagnostik im PRN-Schema zu einer konsequenten Behandlung und den notwendigen Kontrolluntersuchungen der Patienten über einen langen Zeitraum führen kann.

Abstract

Background For many maculopathies, the management of intravitreal injection (IVOM) presents a logistical challenge. To ensure contemporary and timely treatment, patients have to organise their rides to the surgery, and the clinic has to provide enough short term resources. The objective of this study is an evaluation of the IVOM therapy for patients with exudative AMD according to four quality indicators a) latency time within the treatment and monitoring cycle, b) the treatment and monitoring frequency, c) the adherence and d) the medical outcome.

Materials and Methods For more than seven years, patients with exudative AMD have been treated by many ophthalmologists using a networked portal system. Therefore, conservative doctors and surgical eye centres exchange treatment-relevant data. In total there are documented 2283 eyes of 1850 patients. We evaluate these electronic medical records retrospectively according to the mentioned quality indicators.

Results This evaluation results in a latency time from OCT monitoring and the start of a new IVOM series of 8.1 working days. Within the first two treatment years, we achieve 10.5 injections and 8.2 monitoring visits in average. After two years, 72.9% of the cases were still in treatment or monitoring. We observed stabilisation of mean visual accuracy of about 0.05 logMAR.

Conclusions To improve the visual acuity, it is essential to achieve consistent therapy over a long period of time, especially in the case of treatment-relevant exudative AMD. The evaluation of our treatment system demonstrated that the PRN-scheme can be implemented by a cooperatively organised IVOM therapy. It is possible to achieve rapid retreatment and good adherence over many treatment years. For treatment-relevant exudative AMD it is essential for the improvement of the visual accuracy to implement consistent therapy over a long period of time. The evaluation of our treatment system demonstrates that the PRN scheme can be implemented in a cooperatively organised IVOM therapy. It is possible to achieve rapid retreatment and good patientsʼ adherence over many treatment years.

Schlüsselwörter

exsudative AMD - Telemedizin - Patientenadhärenz

Key words

exudative AMD - adherence - treatment latency - IVOM therapy - telemedicine - cooperative treatment management

Publication History

Received: 19 April 2019

Accepted: 15 July 2019

Article published online:
25 October 2019

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