Abstract
Aims
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.
Methods
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.
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.
Conclusions
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.
Similar content being viewed by others
References
Avery RL, Fekrat S, Hawkins BS et al. (1996) Natural history of subfoveal subretinal hemorrhage in age-related macular degeneration. Retina 16:183–189
Barnes PM, Powell-Griner E, McFann K et al. (2004) Complementary and alternative medicine use among adults: United States, 2002. Adv Data 27:1–19
Bennett AR, Folk JC, Blodi C et al. (1990) Factors prognostic of visual outcome in patients with subretinal hemorrhage. Am J Ophthalmol 109:33–37
Cho YC, Tsay SL (2004) The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease. J Nurs Res 12:51–59
Clearly PD, Mc Neil BJ (1988) Patient satisfaction as an indicator of quality of care. Inquiry 25:25–36
Dawn AG, Santiago-Turla C, Lee PP (2003) Patient expectations regarding eye care. Arch Ophthalmol 121:762–768
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 15:42–47
Edge J (2003) A pilot study addressing the effect of aromatherapy massage on mood, anxiety and relaxation in adult mental health. Complement Ther Nurs Midwifery 9:90–97
Hall JA, Epstein AM, DeCiantis ML et al. (1993) Physicians’ liking for their patients: more evidence for the role of affect in medical care. Health Psychol 12:140–146
Hall JA, Roter DL, Katz NR (1988) Meta-analysis of correlates of provider behaviour in medical encounters. Med Care 26:657–675
Hall NF, Gale CR (2002) Prevention of age-related macular degeneration. BMJ 325:1–2
Herriot W (1996) Intravitreal gas and TPA: an outpatient procedure for subretinal hemorrhage. Presented at the Vitrectomy Meeting; October 10-15, Vail, Colorado
Hesse L, Kroll P (1997) Successful treatment of acute subretinal hemorrhage in age-related macular degeneration by combined intravitreal injection of recombinant tissue plasminogen activator and gas. Adv Ther 14:275–280
Holladay JT, Prager TC (1991) Mean visual acuity (letter). Am J Ophthalmol 111:372–374
Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70
Howe LJ (2003) Management of age-related macular degeneration: still room for improvement. Br J Ophthalmol 87:375
Ibanez HE, Williams DF, Thomas MA et al. (1995) Surgical removal of submacular hemorrhage. A series of 47 consecutive cases. Arch Ophthalmol 113:62–69
Janis J, Mann L (1977) Decision making: a psychological analysis of conflict, choice and commitment. Free Press, New York
Kaplan SH, Greenfield S, Ware JE Jr (1985) Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med 102:520–528
Kaplan SH, Greenfield S, Ware JE Jr (1989) Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care S1:10–27
Kincey J, Bradshaw P, Ley P (1975) Patients' satisfaction and reported acceptance of advice in general practice. J R Coll Gen Pract 25:558–576
Krepler K, Kruger A, Tittl M et al. (2000) Intravitreal injection of tissue plasminogen activator and gas in subretinal hemorrhage caused by age-related macular degeneration. Retina 20:251–256
Mainz J (2004) Quality indicators: essential for quality improvement. Int J Qual Health Care 16:i1–i2
Mitchell J, Bradley P, Ffytche T et al. (2002) Perceived quality of health care in macular disease: a survey of members of the Macular Disease Society. Br J Ophthalmol 86:777–781
Monestam E, Wachtmeister L (1999) Dissatisfaction with cataract surgery in relation to visual results in a population-based study in Sweden. J Cataract Refract Surg 25:1127–1134
Mozaffarieh M, Benesch T, Krepler K et al. (2005) Photocoagulation for diabetic retinopathy: determinants of patient satisfaction and the patient-provider relationship. Acta Ophthalmol Scand 83:316–321
Nelson CW, Niederberger J (1990) Patient satisfaction surveys: an opportunity for total quality improvement. Hosp Health Serv Admin 35:409–427
Roter DL (1977) Patient participation in patient-provider interactions: the effects of patient question asking on the quality of interaction,satisfaction and compliance. Health Educ Monogr 5:281–315
Scheider A, Gündisch O, Kampik A (1999) Surgical extraction of subfoveal choroidal new vessels and submacular haemorrhage in age-related macular degeneration: results of a prospective study. Graefe's Arch Clin Exp Ophthalmol 237:10–15
Scott IU, Smiddy WE, Feuer W et al. (1998) Vitreoretinal surgery outcomes. Results of a patient satisfaction/functional status survey. Ophthalmology 105:795–803
Scupola A, Coscas G, Soubrane G et al. (1999) Natural history of macular subretinal hemorrhage in age-related macular degeneration. Ophthalmologica 213:97–102
Tsai SC, Lin JM, Chen HY (2003) Intravitreous recombinant tissue plasminogen activator and gas to treat submacular hemorrhage in age-related macular degeneration. Kaohsiung J Med Sci 19:608–616
Wade EC, Flynn HW, Olsen KR et al. (1990). Subretinal hemmorhage management by pars plana vitrectomy and internal drainage. Arch Ophthalmol 108:973–978
Walach H, Guthlin C, Konig M (2003) Efficacy of massage therapy in chronic pain: a pragmatic randomized trial. J Altern Complement Med 9:837–846
Acknowledgements
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mozaffarieh, M., Heinzl, H., Sacu, S. et al. In-patient management and treatment satisfaction after intravitreous plasminogen activator injection. Graefe's Arch Clin Exp Ophthalmo 244, 1421–1428 (2006). https://doi.org/10.1007/s00417-005-0232-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-005-0232-z