Task shifting of intraocular injections from physicians to nurses: a randomized single-masked noninferiority study.

Abstract

PURPOSE:

To test if task shifting of intraocular injections to nurses in a real-world setting can result in similar visual function outcome with equal safety profile.

METHOD:

All patients with either age-related macular degeneration, retinal vein occlusion or diabetic macular oedema remitted to intraocular injections at a tertiary ophthalmology department in Norway between March 2015 and May 2017, were asked to participate. The participants were randomized to either nurse- or physician-administered intraocular injections of anti-vascular endothelial growth factor. The primary outcome measure was change in best-corrected visual acuity from baseline to 1-year follow-up. The mean difference in the primary outcome between the groups was analysed by a noninferiority test with a margin of three letters in disfavour of the nurse group. Adverse events were recorded.

RESULTS:

Three hundred and forty-two patients entered the study. Two hundred and fifty-nine completed the 1-year follow-up and were included in the study sample for the analysis of the primary outcome. Nurse-administered intraocular injections were noninferior to physician-administered injections with 0.7 and 1.6 letters gained, respectively (95% CI of the mean difference, -2.9 to 1.0; p = 0.019, one-sided t-test). Two thousand and seventy-seven injections and three ocular adverse events were recorded.

CONCLUSION:

Task shifting of intraocular injections to nurses can be performed without increased risk to visual function. Such a task shift can alleviate the burden of performing intraocular injections in ophthalmology departments. To our knowledge, this is the first RCT on task shifting of a surgical procedure from physicians to nurses in a high-income country.

• Authors: Stine Bolme, Tora Sund Morken, Turid Follestad, Torben Lykke Sørensen, Dordi Austeng
• Journal: Acta ophthalmologica (Acta Ophthalmol) Vol. 98 Issue 2 Pg. 139-144 (Mar 2020) ISSN: 1755-3768 [Electronic] England
• PMID: 31267688 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2019 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.

Chemical References

• Angiogenesis Inhibitors
• Recombinant Fusion Proteins
• VEGFA protein, human
• Vascular Endothelial Growth Factor A
• aflibercept
• Bevacizumab
• Receptors, Vascular Endothelial Growth Factor
• Ranibizumab

Topics

• Adult
• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (administration & dosage)
• Bevacizumab (administration & dosage)
• Diabetic Retinopathy (drug therapy, physiopathology)
• Female
• Follow-Up Studies
• Humans
• Intravitreal Injections
• Macular Edema (drug therapy, physiopathology)
• Male
• Middle Aged
• Norway
• Nurses (organization & administration)
• Ophthalmologists (organization & administration)
• Patient Satisfaction
• Primary Health Care (organization & administration)
• Prospective Studies
• Ranibizumab (administration & dosage)
• Receptors, Vascular Endothelial Growth Factor (administration & dosage)
• Recombinant Fusion Proteins (administration & dosage)
• Retinal Vein Occlusion (drug therapy, physiopathology)
• Single-Blind Method
• Surveys and Questionnaires
• Task Performance and Analysis
• Tomography, Optical Coherence
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Visual Acuity (physiology)
• Wet Macular Degeneration (drug therapy, physiopathology)