In-patient management and treatment satisfaction after intravitreous plasminogen activator injection
- 103 Downloads
To assess patient satisfaction after intravitreous plasminogen activator injections for subretinal hemorrhages secondary to age-related macular degeneration (AMD) and to analyse how it relates to the patients' postoperative visual and functional abilities. Further, to suggest ways to improve in-patient management and thereby treatment satisfaction.
A consecutive series of 101 patients with a subretinal hemorrhage of at least one disk diameter were enrolled in this longitudinal prospective study conducted during 2001–2004. After complete preoperative eye examination all patients were treated with intravitreal injection of 25 μg recombinant tissue plasminogen activator (rTPA) and 0.5 ml sulphur hexafluoride gas (SF6), followed by face-down positioning for 1 week. Patient satisfaction was assessed using standardised questionnaires administered postoperatively at 4 and 12 months. Outcome measures were: (1) responses to the patient satisfaction survey, (2) degree of satisfaction with in-patient management, (3) subjective change in the patients' functional status, and (4) visual acuity results.
Whereas the patients' actual functional status deteriorated from a median value of 2.4 at 4 months to 3.4 at 12 months, their recall of their preoperative functional status shifted from a median value of 4.2 to to 2.3, consecutively. Twelve months after treatment, 75% of patients reported an improved visual acuity, however, only 12% reported satisfaction with treatment. 67.4–87% of patients were dissatisfied with various areas of in-patient management.
Satisfaction with plasminogen activator injection treatment is low even though patients experience an improved visual and functional status at 12 months. This suggests that the current system requires improvement in certain areas such as in-patient management.
KeywordsIntravetreous injection Plasminogen activator injection Subretinal hemmorhage Age-related macular degeneration Patients’ satisfaction
We would like to thank all patients who actively took part in this study and made it possible. We would also like to thank Professor Frischenschlager, for his wise suggestions on cognition.
- 2.Barnes PM, Powell-Griner E, McFann K et al. (2004) Complementary and alternative medicine use among adults: United States, 2002. Adv Data 27:1–19Google Scholar
- 7.Dolinsky AL (1995) Complaint intensity and health care services: a framework to establish priorities for quality improvements can be used to improve patient satisfaction. J Health Care Marketing 15:42–47Google Scholar
- 12.Herriot W (1996) Intravitreal gas and TPA: an outpatient procedure for subretinal hemorrhage. Presented at the Vitrectomy Meeting; October 10-15, Vail, ColoradoGoogle Scholar
- 15.Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70Google Scholar
- 18.Janis J, Mann L (1977) Decision making: a psychological analysis of conflict, choice and commitment. Free Press, New YorkGoogle Scholar
- 20.Kaplan SH, Greenfield S, Ware JE Jr (1989) Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care S1:10–27Google Scholar
- 27.Nelson CW, Niederberger J (1990) Patient satisfaction surveys: an opportunity for total quality improvement. Hosp Health Serv Admin 35:409–427Google Scholar