Role and Capabilities of a General Practitioner/Family Physician in Early Detection and Follow-Up Monitoring Primary Glaucoma Patients

Detsyk O. Z., Mytnyk Z. M., Koshchynets O. B.

CONTENTS

Scentific article

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 com- pleteness 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 de- tected 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 in- creased 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 glau- coma (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 per- formed 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 cov- erage 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 cover- age of screening, monitoring implementation of the recommendations of medical professionals.

primary glaucoma, prevention, screening, follow-up monitoring, general practitioner/family physician

• Інтеграція Національної стратегії боротьби зі сліпотою до 2020 року до основних концептуальних напрямів реформу- вання охорони здоров’я / Д. В. Варивончак, С. О. Риков, Н. А. Обухова [та ін.] // Архів офтальмології України. – 2013. – Т. 1, №1. – С. 11-17
• Здоровье 2020. Основы европейской политики и стратегия для ХХІ века / Всемирная организация здравоохранения: Европейское бюро ВОЗ, 2013. – 232 с.
• Катаракта как осложнение антиглаукоматозных операций при первичной открытоугольной глаукоме / К. П. Павлючен- ко, В. О. Пенчук, С. Ю. Могилевський [та ін.] // Архів офтальмології України. – 2013. – Т. 1, №1. – С. 115-120. Кощинець О. Б. Особливості соціально-економічного статусу хворих на глаукому / О. Б. Кощинець, З. М. Мит- ник  //  Матеріали  міжнародної  науково-практичної  конференції  присвяченої  Всесвітньому  дню  здоров’я  // Східноєвропейський журнал громадського здоров’я. – 2012. – С. 162-163.
• Риков С. О. Сліпота і слабкозорість. Шляхи профілактики в Україні : Науково-методичне видання / За редакцією проф. Рикова С. О. – К.: ТОВ «Доктор-Медіа», 2011. – 268 с.
• Quigley H. A. The number of people with glaucoma worldwide in 2010 and 2020 / H. A. Quigley, A. T. Broman // Br. J. Ophthal- mol. – 2006. – № 90. –Р. 262–267.
• Vision 2020. The right to sight. Global Initiative for the elimination of avoidable blindness. Action plan 2006-2011 [Electron resource] / WHO, 2007. – 97 p.: Access: http://www. who. int/blindness/Vision2020_report. pdf.

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