【作者】 吴静；

【导师】 张铭志；

【作者基本信息】 汕头大学 ， 眼科学， 2010， 硕士

【摘要】 目的:深入了解中国农村地区那些在白内障筛查中建议做手术的人们所面临的困难,并与那些自愿来到诊所检查或要求手术的病人面临的困难与特点进行比较。通过进一步了解那些建议接受手术却未进行手术的人们的原因,以增加中国农村地区的白内障手术率。方法:有关白内障手术率的前瞻性研究。调查对象来自于同一个镇,14个村的27个筛查点以及当地镇人民医院的眼科门诊,所有的入选病人都满足至少单眼针孔矫正视力≤0.3,且由专门的眼科医师诊断患有白内障。所有入选患者需回答我们关于影响接受白内障手术因素的问卷:主要包括(1)、对白内障的了解;(2)、对手术质量的认可程度;(3)、患者就医的交通便利性;(4)经济因素。结果:入选的筛查组(n=120)与门诊组(n=120)患者与所有调查人群在年龄、性别及视力方面差异无统计学意义。与门诊组相比,筛查组的患者中女性比例较高(P=0.002),居住面积相对较小(P<0.001),受教育程度较低(P<0.001);而门诊组的患者视力相对较差,盲(视力≤0.1)的比例较高(P<0.001),且更愿意付钱做手术(P<0.001)。从logistic回归模型可见,筛查组患者对手术质量的评分低于门诊组(P<0.001),而视力相对较好(P=0.02),在对白内障的认识得分方面,筛查组中愿意做手术的病人较不愿意的病人的有较高得分。结论:在中国农村地区,筛查发现的白内障患者与自愿来医院就诊的患者在性别、经济、教育以及对白内障的认识程度等方面具有显著的差异。另一方面,筛查在提高人们对白内障认识方面有潜在作用,我们可以通过加强关于白内障知识的普及与宣教来增加筛查患者的手术率。更多还原

【Abstract】 Purpose: This project seeks to better understand the barriers faced by rural patients who are recommended cataract surgery during screening programs in actually obtaining cataract surgery at rural China, in comparison to the features and barriers of patients who spontaneously self-present to the clinic and request cataract surgery. By better understanding the reasons for not undergoing surgery among those who are recommended to have surgery, we hope to increase the uptake of surgical services in rural China.Method: This is a prospective study about cataract surgery rate. Subjects were recruited from 27 screenings and an eye clinic in the same town. All had pinhole-corrected vision≤6/18 in≥1 eye due to ophthalmologist-diagnosed cataract. Subjects were administered a previously-validated questionnaire on barriers to surgery in four areas: Knowledge (K), Perceptions of Quality (Q), Transportation (T) and Cost (C).Result: Screening Group (SG, n = 120) and Clinic Group (CG, n = 120) participants did not differ from eligible, examined screening and clinic patients respectively in age, gender or vision. SG participants were significantly more likely to be female (P = 0.002) and had smaller housing area and less education (P < 0.001 for both) than those in the CG. Those in the CG were more likely to be blind (habitual VA≤6/60) in the better-seeing eye (P = 0.05) and more willing to undergo and pay for cataract surgery (P < 0.001 for both) than SG. In logistic regression models, SG subjects had significantly lower quality scores (P < 0.001) and better habitual vision (P = 0.02) than did CG participants, and SG participants who agreed to cataract surgery (78.3%) had significantly higher knowledge scores (P < 0.001) than those refused.Discussion: Screening outreach has the potential to ameliorate disparities in access to cataract surgery in rural China, as it appears more likely to detect cataract patients with gender-related, economic, educational and attitudinal barriers to surgery. However, education may be needed to convince screening subjects to undergo surgery.更多还原