Community-based health management combined with tertiary hospital care significantly improves disease cognition, ocular symptoms, psychological well-being, and quality of life in patients with dry eye syndrome compared with routine self-care, according to results from a study published in Ophthalmic Epidemiology.
Between January and September 2023, 500 adults were recruited from a tertiary hospital (n=250) and a community health station (n=250) in Changzhou, China. Of 243 high-risk individuals, 132 were diagnosed with dry eye disease and randomized to a management group (structured community care, n=66) or control group (routine self-care, n=66). Outcomes were measured at baseline and 6 months, including disease cognition, ocular function (tear break-up time [BUT], Schirmer, OSDI), psychological state (as determined using the self-rating anxiety scale [SAS] and self-rating depression scale [SDS]), eye comfort visual analog scale (VAS), gastrointestinal quality of life index (GQLI), and satisfaction.
At baseline, 24.24% of patients had mild disease (OSDI 0–20), 40.91% had moderate disease (OSDI, 21-45), and 34.85% had severe disease (OSDI 46–100). Univariate analysis identified several significant risk factors, including older age, female sex, ocular/systemic drug use, connective tissue disease, laser refractive surgery, vitamin A deficiency, hepatitis C, mite infection, anxiety, depression, sleep disorder, and diabetes (all P <.05). In contrast, drinking alcohol, smoking, hypertension, and thyroid disease were not significantly associated (P >.05).
After 6 months, patients in the management group showed significantly greater improvement than controls. Disease cognition improved substantially, with 86.36% of the management group achieving “good” knowledge compared with 62.12% in controls (P =.012). Both groups demonstrated improvements in BUT, SIT, and OSDI scores, but gains were significantly larger in the management group (P <.05).
Based on the new model of community health management combined with diagnosis and treatment in tertiary hospitals, it is helpful to improve the clinical symptoms of patients with dry eye, improve their psychological state, and correct their wrong cognition.
Psychological outcomes also improved, with SAS scores decreasing from 59.65±6.48 to 44.42±5.06 and SDS from 56.98±5.49 to 48.62±5.35 in the management group; reductions were smaller in controls (SAS 60.25±7.02 to 50.68±6.14; SDS 57.33±5.86 to 52.69±5.98), with between-group differences highly significant (SAS, t=6.392, P <.001; SDS, t=4.121, P <.001).
Visual analog scale discomfort scores decreased and GQLI quality-of-life scores increased in both groups, with significantly greater changes in the management group (P <.05). Subgroup analyses showed that patients with moderate or severe dry eye experienced the most pronounced benefits from community-based management, whereas improvements in mild cases were less distinct between groups.
“Based on the new model of community health management combined with diagnosis and treatment in tertiary hospitals, it is helpful to improve the clinical symptoms of patients with dry eye, improve their psychological state, and correct their wrong cognition,” the researchers explain.
Study limitations include the use of the GQLI rather than an eye-specific quality-of-life tool, the persistence of financial burdens for patients despite improved care, and the need to evaluate cost-effectiveness and affordability before broader implementation.
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