ABSTRACT
BACKGROUND: There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles. AIMS: To examine mental health and burnout rates, and possible drivers for any disparities between professional roles. METHODS: In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role. RESULTS: At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors. CONCLUSIONS: Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.
ABSTRACT
Objectives: Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is efficacious for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). However, the frequent treatment and monitoring required for optimal real-world outcomes can be burdensome to patients and can impact adherence to treatment. This study aimed to understand patient treatment experience with anti-VEGF standard of care. Method(s): A cross-sectional survey was employed comprising de novo questions, patient-reported outcome (PRO) measures and medical chart extraction. Adult patients with nAMD or DME treated with intravitreal anti-VEGF injections for >=12 months were recruited via 38 clinical sites (6 Canada, 6 France, 4 Italy, 7 Spain, 6 United Kingdom, 9 United States). Result(s): Surveys were completed by 391 patients with nAMD and 183 patients with DME. PRO scores indicated that patients across both conditions had relatively high vision-related functioning and were generally satisfied with their current treatment. Mean number of anti-VEGF injections over 12 months across countries ranged from 6.3-9.7 for nAMD and 4.3-8.0 for DME. Nineteen patients with nAMD (19/391;5%) and 27 patients with DME (27/183;15%) missed >=1 injection or examination visit in the past 12 months. Reported barriers were mainly related to treatment (eg, pain and discomfort during/after anti-VEGF injection), clinic (eg, not having someone to accompany them to appointments) and, to a lesser extent, the COVID-19 pandemic. After treatment, the majority recovered in <=1 day;however, 24% (139/574) needed >1 day to recover. Impairment in daily activities due to treatment was reported by 45% (258/574) of patients. Among working patients 62% (41/66) reported productivity impairment from absenteeism. Conclusion(s): Patients reported impairment of daily activities, burden and barriers related to intravitreal anti-VEGF therapy, despite high adherence and treatment satisfaction levels. More durable therapy options, requiring less frequent treatments may be able to reduce treatment-related burden and barriers. Copyright © 2022
ABSTRACT
Objectives: Optimal real-world outcomes in neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) require frequent and potentially burdensome visits for patients and their caregivers. This study aimed to understand the caregiver perspective on treatment burden, barriers and the impact of caregiving, with a particular focus on the demands of frequent anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection treatment. Methods: Caregivers of adult nAMD/DME patients treated with anti-VEGF injections were enrolled from 21 clinical sites in the USA, UK and Canada. Caregivers completed a cross-sectional survey comprising de novo questions and a self-reported outcome instrument. Results: Overall, 18 DME and 44 nAMD caregivers completed surveys. On average, caregivers provided care 4.3±3.0 days/week, 4.0±4.3 hours/day. Caregivers reported supporting patients on a diverse array of tasks including transportation to doctors' appointments, providing emotional support, and helping with shopping and household chores. Twelve (67%) DME and 30 (68%) nAMD caregivers reported at least one barrier that prevented patients from receiving treatment or attending visits. Barriers were mainly related to the COVID-19 pandemic restrictions, particularly preventing caregivers from accompanying patients to appointments, clinic/appointment factors (distance, difficulty in scheduling appointments, other medical appointments priority, appointment duration), and social/health related factors (caregiver’s availability, care recipient’s reduced mobility/physical limitations). Overall, 13/22 (59%) working caregivers reported an impact on work absenteeism due to helping with treatment appointments. Based on the Caregiver Reaction Assessment scores, caregivers experienced a moderate impact on schedule disruptions, and a milder impact on financial problems, lack of family support, health and self-esteem in relation to their caregiving situation. Conclusions: Caregivers devote significant time to caring for the recipient, with the greatest impact on caregiver schedule disruptions and absenteeism for those working. More durable treatments with longer intervals and fewer appointments may alleviate some of that burden.