Indication criteria for cataract extraction and gender differences in waiting time

Abstract

ABSTRACT.Purpose: The purpose of this study was to investigate national indication criteria tool for cataract extraction (NIKE), a clinical tool for establishing levels of indications for cataract surgery, in relation to gender differences in waiting times for cataract extraction (CE).Methods: Data were collected by The Swedish National Cataract Register (NCR).Eye clinics report to NCR voluntarily and on regular basis (98% coverage). Comparisons regarding gender difference in waiting times were performed between NIKE-categorized and non-NIKE-categorized patients, as well as between different indication groups within the NIKE-system. All calculations were performed in SPSS version 20. Multivariate analyses were carried out using logistic regression, and single variable analyses were carried out by Student's t-test or chi square as appropriate.Results: Gender, age, visual acuity and NIKE-categorization were associated with waiting time. Female patients had a longer waiting time to CE than male, both within and outside the NIKE-system. Gender difference in waiting time was somewhat larger among patients who had not been categorized by NIKE. In the non-NIKE-categorized group, women waited 0.20 months longer than men. In the group which was NIKE-categorized, women waited 0.18 months longer than men. Conclusions:It is reasonable to assume that prioritizing patients by means of NIKE helps to reduce the gender differences in waiting time. Gender differences in waiting time have decreased as NIKE was introduced and there may be a variety of explanations for this. However, with the chosen study design, we could not distinguish between effects related to NIKE and those due to other factors which occurred during the study period.

Inequity in waiting for cataract surgery - an analysis of data from the Swedish National Cataract Register

“…Gender-related differences in access to CE in Sweden have decreased over the last decade, which may well be related to governmental measurements, for example, a waiting time guarantee [ 7 ]. Even if waiting times for CE in general have been reduced, there still remain waiting time differences related to, for example, gender.…”

“…The earlier month in the study period the patients were placed on waiting list, the longer waiting time they had. This is probably related to a governmental measure called the ‘queue billion’ which was introduced in 2008 and implicates that county councils, which gave patients treatment or operation within 90 days, should have a billion Swedish crowns to share [ 7 ].…”

“…The Swedish Health and Medical Services Act states: “Health and medical services are aimed at assuring the entire population good health and care on equal terms” [ 1 ]. Numerous studies, however, indicate that women and men have different access to and experience different quality in health care [ 2 – 7 ]. Studies also report inequalities in the Swedish health care services between different socioeconomic groups and ethnic groups [ 8 ], for example, that newer and more expensive drugs are more often prescribed to patients from higher social positions [ 9 – 11 ].…”

“…One of the areas in Swedish health care that has attracted attention for potential inequity is Cataract Extraction (CE). Previous studies of access to CE in Sweden show that even though female patients are in the majority, they also have in general poorer vision before they are operated and longer waiting times for CE than male patients [ 3 , 7 , 10 ]. CE is a relatively simple and safe operation, where neither general anaesthesia nor in-patient care is needed.…”

Patients’ maximum acceptable waiting time for cataract surgery: a comparison at two time‐points 7 years apart

“…; Ng & Lundstrom ; Smirthwaite et al. ). The validity of priority criteria tools for elective surgery has been described in the published literature (Conner‐Spady et al.…”