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J.C. Pastor, J. Rojas, I. Fernandez, F. Gomez–Ulla, A. Piñero; Profile of Surgical Retinal Diseases Management at the Public Hospitals of the National Health Service (NHS): Results of a Survey in Spain. Retina 2 Project . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1482.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the profile of vitreo retinal surgery management and the after hours retinal detachment (RD) care at the hospitals of NHS in Spain
217 heads of Ophthalmology services of the NHS hospitals across Spain were asked to complete a confidential questionnaire with 30 items, 9 related to the management of after–hours RD and 2 theoretical cases of RD with macula–on arriving on Friday afternoon. Qualitative variables were analyzed by Chi–squared and Fisher’s exact tests and quantitative by Kruskall–Wallis test
119 answers (answer rate: 54.84%) were received. Feedback came mainly from high level teaching hospitals (TH: 67 out of 148). District general hospitals and non teaching hospitals (NTH) were grouped together (49 out of 69). Approximately 64% (75/116) of the centres perform pars plana vitrectomy (PPV) and 83% (95/115) scleral surgery. Almost 70% (48 / 69) of the performing PPV centres do over 100 programmed PPV per year and 15% less than 50 PPV. There is a mean of 2 vitreo–retina specialists (VR) per centre, the 23% of the mean staff (14 in TH and 5 in NTH); mean population covered by each hospital is 274.800 inhabitants. VR specialists perform a median of 50 PPV per year (60 in TH and 24 in NTH). Approximately 77% (52/68) of the centres with PPV cover urgent RD but only 36% have VR specialist on call. Furthermore 80% (95) of centres admit to have problems in handling urgent RD after–hours; 24% (27/115) due to the lack of theatre availability, ophthalmic trained nurses 78% (89/114), and anaesthetists 49% (40/81). An hypothetical patient with a superior RD, macula–on and visual acuity of 20/20 coming on Friday afternoon must be ideally treated in less than 24 hours for 44% of the responses, but both hospitals, with and without VR specialists on call, recognized that over 90% of those patients are treated after more than 24 hours. Only 40% (29/72) of centres internally audit their results (38% TH and 2% NTH).
Despite the cautions that should be taken with sample selection and the ignorance of the non–response bias, we learned the number of programmed PPV done in the last year, the problems faced by the NHS concerning urgent RD management, the specialists involved in vitreoretinal diseases care, and centres auditing their results. The results of this survey provide important information for the Health Authorities to organize an efficient coverage of surgically–managed retinal diseases
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