الفهرس | Only 14 pages are availabe for public view |
Abstract Adherence to guidelines offers the chance to improve clinical outcomes and quality of care provided to patients by reducing practice variation. Due to changes in research findings and recently available diagnostic and therapeutic interventions, guidelines should be assessed for validity and updated on a regular basis. Increasing efforts are being taken to implement guidelines but some factors hinder physicians from adopting them including lack of financial resources, deficient physicians’ knowledge about guidelines and their training on them. Aim of the study: To study physicians’ adherence to guidelines of the International Council of Ophthalmology (ICO) in initial evaluation of primary open angle glaucoma patients in Alexandria General Eye Hospital, Egypt. Target population and study sample: A cross-sectional analytical study design was conducted on all physicians attending the outpatient clinics of Alexandria General Eye Hospital, Egypt (around 70) and all medical records of primary open angle glaucoma patients who were examined by these physicians during their initial visit. Data collection methods and tools: 1. A checklist was developed by the international council of ophthalmology is used to record the adherence of the assigned physician to the stated guidelines and to review medical records of patients diagnosed with primary open angle glaucoma. 2. A Self-administered questionnaire is presented to the observed physicians to discover their opinions about important issues related to the present study The results of the present study revealed the following: More than one third of ophthalmologists did not know about the presence of glaucoma guidelines in the first place. More than half of ophthalmologists are not committed to guidelines while managing glaucoma patients. Most of ophthalmologists rely only on their own experience in glaucoma management. Most of ophthalmologists found standardization of glaucoma practice and specially the ICO guidelines is either excellent or very good. A great discrepancy detected between the performed examination and the documented results by ophthalmologists. More than three fourths ophthalmologists do not document their examination results in medical records. Most of examination processes observed either directly or through medical records were not adherent to the ICO glaucoma guidelines. The major barriers that hinder the application of ICO glaucoma guidelines were lack of financial and scientific resources. There were statistically significant relations between ophthalmologists’ job title and years of experience on a hand and adherence to glaucoma guidelines in general on the other hand. Another statistically significant relation between ophthalmologists’ qualifications, job title and years of experience on a hand and level of adherence to ICO glaucoma guidelines specifically on the other hand. The following recommendations were suggested: 1. Recommendations for Alexandria Faculty of Medicine: The concept of standardization should be integrated in the under and post-graduate medical curriculum. Training on the use of guidelines should be provided to house officers. 2. Recommendations for Ministry of Health and Population: Policies should be developed to introduce the ICO glaucoma guidelines as a national reference, apply regular training programs on the use of these guidelines and regularly audit the examination process. Instruments required by the guidelines should be provided. 3. Recommendations for Alexandria General Eye Hospital: Reporting difficulties that face the application or adherence to ICO glaucoma guidelines to authorities. Improving documentation practices and providing ophthalmologists with regular training programs. . 4. Recommendations for further research: Apply similar studies on the application of ICO guidelines in other ophthalmic diseases and other healthcare sectors as university, health insurance and military hospitals. |