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R. Ahmed, P.H. Keckley, F.M. Recchia, P. Sternberg, Jr., A. Agarwal; Evaluation of Adherence to Clinical Practice Guidelines in the Treatment of Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2187.
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Variations in practice patterns and quality concerns have prompted the development of evidence–based practice guidelines. It has been previously reported that patients receive recommended care processes across a variety of quality care indicators only 55% of the time. In the treatment of ophthalmic conditions, the most widely accepted set of guidelines is the American Academy of Ophthalmology’s Preferred Practice Pattern (PPP), but there has been little evaluation of the "real–world" application of its recommendations for age–related macular degeneration (AMD). The purpose of this study was to evaluate adherence to AMD practice guidelines by looking at two study questions: (1) How often is Amsler grid testing performed as part of examinations in patients with AMD? (2) How often is antioxidant supplementation recommended for patients at high–risk for development of advanced AMD (AREDS Group IV)?
107 patient charts were randomly selected from a retrospective review of all patients seen by three retinal specialists between 1/1/04 and 12/31/04 with a diagnosis of AMD. Visits between 1/1/00 and 10/31/05 were reviewed for the following information: (a) diagnosis and severity of AMD by AREDS classification; (b) documentation of Amsler grid testing; (c) documentation of the recommended use of antioxidant and mineral supplementation. The rates of documentation of Amsler grid testing and supplement recommendation were recorded for each retinal specialist. These rates were then compared by the chi–square test.
A total of 317 visits were reviewed. The overall rate of Amsler grid testing was 48%, and there was no significant difference among specialists. The overall rate of documented recommended use of antioxidant supplements was 47%. However, there was a significant statistical difference between one specialist (20%, N=41) and the other two (77%, N=26 and 54%, N=50, respectively; p < 0.001).
Although the overall rates of adherence to some aspects of the PPP guidelines for management of patients with AMD are similar to adherence rates of recommended care processes in other fields, they still are only in the range of 50%. While possible explanations for these relatively low rates may include failure to document a verbal recommendation, differences in years of training, or unawareness of treatment guidelines, there is considerable room for improvement.
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