OBJECTIVES

Anti­vascular endothelial growth factor (anti­-VEGF) intravitreal injections are crucial treatments for several ophthalmological disorders. There are geographic variations in anti-VEGF treatment rates in Portugal, indicating probable access differences. The aim of this study was to analyze factors correlated with geographic variations in anti-VEGF treatment rates in Portugal.

METHODS

Using an administrative database of inpatient and day case stays during the period 2013-2018, cases corresponding to anti-VEGF injections in the Portuguese National Health Service were identified. Statistical analyses were conducted to investigate the correlation of individual patients’ characteristics (age, sex, distance to hospital), ecological supply variables (number of ophthalmology consultations) and hospital characteristics (number of ophthalmologists and organizational level, which includes equipment availability and emergency type and opening hours) with anti-VEGF rates per 100,000 inhabitants with ≥50 years, at the municipal and hospital level. These associations were analyzed using correlation analysis, Mann-Whitney and Kruskal-Wallis tests.

RESULTS

Anti-VEGF injection rates varied up to 14-fold by municipality. At the individual level, users in the municipalities with higher anti-VEGF rates had to travel shorter distances between their residence and the hospital than users in municipalities with lower anti-VEGF rates (2018, p-value=0.002). At the ecological level, there was a small correlation of higher anti-VEGF rates with greater number of ophthalmology consultations (2016, Spearman’s ρ=0.156; p-value=0.018), although not observed for all analyzed years. At the hospital level, a higher ratio of ophthalmology specialists was correlated with higher anti-VEGF treatment rates (Spearman’s ρ=0.359; p-value=0.023) while hospitals with higher organizational levels had also higher anti-VEGF treatment rates than other hospitals (p-value=0.029).

CONCLUSIONS

Results indicate that proximity to health care, more access to ophthalmology specialists and hospitals with higher organizational levels are correlated with greater anti-VEGF treatment rates. Improving access is crucial to reduce regional discrepancies and to ensure optimal treatment frequency, which can ultimately improve health outcomes.