In this multi-centre, prospective, observational, time and motion study the authors assessed the time burden of managing wet AMD for doctors, staff, patients and caregivers in the USA. The study spanned the period from March 2011 to August 2012, and surveys were conducted of 56 retina specialists across the country that provided data for 221 patients. There were three parts to the study: 1) ethnographic data collection, 2) qualitative patient and care givers interviews and 3) quantitative surveys of both patients and retinal specialists. Another qualitative survey was conducted of 75 wet AMD patients who had received at least 1 anti-VEGF injection in the previous six months, including preparation for the appointment, travel, waiting times, treatment times and post intervention recovery. Thirteen caregivers were interviewed by phone about the time investment to provide transport to appointments. The results were interesting: around 23 healthcare staff members (receptionist, practice manager, billing manager, technicians, doctors) were involved, with 20% of their work time per week invested in the management of wet AMD patients. The average time spent by patients per visit was 90 minutes, ranging from 13 minutes to more than four hours. The patients themselves spent almost 12 hours per visit and that included pre-appointment preparation (16 minutes), travel (66 minutes), waiting time (37 minutes), treatment time (43 minutes) and post-appointment recovery time (nine hours). Seventy-two percent of patients were driven to their appointment by a caregiver, who in the majority was a spouse / partner (65%), followed by an adult child or grandchild (22%), or friend (7%). Twenty percent of patients drove themselves to the appointment. The care givers time investment for transportation accounted between 22% (time away from work) and 28% (time away from personal activities). The majority of retina specialists thought that the frequency of injections and associated patient visits were the biggest contributor to the disproportionate use of materials and office space. The authors conclude that the management of wet AMD places a hefty time burden to all staff involved as well as a quality of life burden for patients and care givers. They point out the strength of their study with its very comprehensive methodology, including both physician and patient perspectives, and the sampling of retinal specialists from a wide range of locations (20 US states) with a wide patient demographic. They are also aware of the possibility of selection bias in which specialists chose to participate and also the possible effect of potentially inaccurate reporting (reliability of responses). Furthermore they highlight the possible need for additional support and reimbursements for these services and the potential of such a study to be conducted in other countries and markets. 

Disease burden in the treatment of age-­related macular degeneration: findings from a time and motion study.
Prenner JL, Halperin LS, Rycroft C, et al.
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Efrosini Papagiannuli

Birmingham and Midland Eye Centre, Birmingham, UK

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