ObjectiveTo explore the current status of treatment adherence in patients with chronic kidney disease without dialysis and to analyze its influencing factors.MethodsThe patients who visited the Outpatient Department of Nephrology of West China Hospital of Sichuan University from September to December 2020 were taken as the research objects. Self-designed general information questionnaire, treatment adherence questionnaire, physician-patient communication satisfaction, health information seeking behavior questionnaire, and physician-patient concordance questionnaire were used to investigate, and path analysis was used to explore the influencing factors of treatment adherence.ResultsA total of 203 valid questionnaires were obtained. Treatment adherence score was (21.69±2.42) points, self-reported health status was (2.48±0.91) points, physician-patient concordance was (20.39±2.70) points, physician-patient communication satisfaction was (67.73±5.52) points, and health information seeking behavior was (13.17±2.65) points. Health information seeking behavior (r=0.214, P=0.002), physicians-patient concordance (r=0.494, P<0.001), physician-patient communication satisfaction (r=0.229, P=0.001) were positively correlated with treatment adherence. Self-reported health status was negatively correlated with treatment adherence (r=?0.225, P=0.001). Path analysis showed that physicians-patient concordance was the most influencing factor of treatment adherence (total effect=0.474).ConclusionHealth information-seeking behavior and physicians-patient concordance are important factors affecting treatment adherence in chronic kidney disease patients without dialysis. In order to improve treatment adherence of chronic kidney disease patients, healthcare providers can provide various ways to provide information, which can help make more disease-related health knowledge available to patients. Moreover, healthcare workers should also further explore ways to improve the concordance related to reaching agreement between doctors and patients on medical and treatment options.
ObjectiveTo compare and analyze the changes in the diagnosis and treatment of intravitreal injection before and after the implementation of centralized management in the "one-stop intravitreal injection center", and to preliminarily explore the advantages of centralized management. MethodsA retrospective cohort study. A total of 5 954 patients (6 481 eyes) who received intravitreal anti-vascular endothelial growth factor (VEGF) injection in Department of Ophthalmology of Macula Clinic (One-stop Intravitreal Injection Center) of Dalian Third People's Hospital from January 1, 2021 to December 31, 2024 were enrolled. Data were obtained from the Hospital Information System, fundus disease database, and intravitreal injection management software of Dalian Third People's Hospital. Among the patients, there were 2 950 males (3 453 eyes) and 3 004 females (3 528 eyes); 3 163 patients lived in urban areas, and 2 791 in suburban or external areas. Regarding the affected eyes, 1 901 eyes had wet age-related macular degeneration (wAMD), 2 340 eyes had diabetic macular edema (DME), 1 874 eyes had macular edema secondary to retinal vein occlusion (RVO-ME), 580 eyes had diabetic retinopathy (DR), and 390 eyes had other fundus diseases. A total of 19 539 anti-VEGF injections were performed in 6 481 eyes. The control group comprised 2 294 patients (2 630 eyes) from January 1, 2021 to April 30, 2022 (before centralized management), and the observation group comprised 3 660 patients (4 351 eyes) from May 1, 2022 to December 31, 2024 (after centralized management). The total number of intravitreal injections, the distribution of anti-VEGF therapy in patients with wAMD, RVO-ME, DME and other fundus diseases, the completion rates of 3, 5 injections in the first year, and patients' medical experience via telephone interviews were compared between the two groups. The Chi-square test or t-test was used for inter-group comparison. ResultsThe cumulative number of injections in the observation group and the control group was 12 552 and 5 747 times, with the average number of injections per eye being (3.43±2.76) and (2.51±1.73) times. The number of eyes that completed 3 injections in the first year was 2,000 (54.64%, 2 000/3 660) and 968 (42.20%, 968/2 294), while the number of eyes that completed 5 injections in the first year was 762 (20.82%, 762/3 660) and 232 (10.11%, 232/2 294). The average number of injections per eye in the observation group (t=23.56) and the completion rates of 3 and 5 injections in the first year (χ2=87.40, 116.22) were significantly higher than those in the control group, and the differences were statistically significant (P＜0.001). The injection frequency and completion rates of 3 and 5 injections in the first year for patients with DME, RVO-ME, and wAMD in the observation group were significantly higher than those in the control group, and the differences were statistically significant (P＜0.05). Stratified by age, the 5-year completion rates in the observation group were significantly higher than those in the control group in patients aged 41-50, 51-60, 61-70, and ＞80 years old (P＜0.05). The 3-year completion rate of injections in the first year in the observation group was significantly higher than that in the control group, but the difference in the 5-year completion rate (α=0.01) was not statistically significant after adjusting the test level (P=0.004). The total number of injections for patients in the observation group living in urban areas and other regions was significantly higher than that in the control group (P＜0.05). The total discharge time and appointment waiting time for patients in the observation group and the control group were (2.08±0.74) and (2.28±0.63) hours respectively, and the process convenience score was (4.35±0.73) and (3.87±0.98) points respectively, and the medical service satisfaction score was (4.35±0.74) and (4.30±0.84) points respectively. Compared with the control group, the total discharge time and appointment waiting time in the observation group were significantly shortened, the process convenience score was significantly improved, and the differences were statistically significant (t=2.55, 3.80, ?5.09; P＜0.05); there was no statistically significant difference in the medical service satisfaction score between the two groups (t=?0.62, P=0.535). ConclusionCentralized management can significantly enhance the operational efficiency and management level of the "one-stop intravitreal injection center", and improve the patient visit rate and treatment compliance.
