title: Cooperation of German ophthalmologists in routine care of patients with neovascular age-related macular degeneration: results of the non-interventional BRIDGE study.
abstract: OBJECTIVE
  In the non-interventional ophthalmological study 'BRIDGE' the routine care of patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab was observed in Germany. A patient regularly sees the general ophthalmologist (GO) for monitoring and, if needed, the injecting ophthalmologist (IO) for intravitreal injections (IVI). Thus, patients are routinely treated by two ophthalmologists in parallel and patient care depends on their collaboration. This cooperation was evaluated based on network questionnaires.
  
  
  METHODS
  'BRIDGE' was a multicenter, national, open-label, prospective, observational study, conducted between July 2010 and December 2012. The network questionnaire for GOs consisted of 51 questions, while the similar questionnaire for IOs consisted of 43 questions, addressing the type and details of the individual collaboration. The statistical analysis was purely descriptive.
  
  
  RESULTS
  The network questionnaire for GOs was completed by 152 GOs, regularly cooperating with 2.5 ± 1.1 IOs, while the questionnaire for IOs was completed by 43 IOs, regularly cooperating with 23.2 ± 23.6 GOs. Generally, both GOs and IOs stated that they regularly exchange information regarding the patients' situation. Diagnostic standards were only established for 15 % of the GOs' collaborations and for 35 % of the IOs' collaborations. After initial treatment, both GOs and IOs agreed on the medical significance of regular monitoring visits performed by the GOs. Agreements on re-treatment criteria were only established in the case of 16 % of the GOs and 28 % of the IOs. Overall, both GOs and IOs were satisfied with the current situation, with regard to the medical treatment situation for patients and to the cooperation within the networks.
  
  
  CONCLUSIONS
  The network questionnaires revealed well-established cooperation between IOs and GOs in Germany with an accepted division of responsibilities for the routine care of patients with nAMD. However, the cooperation between two ophthalmologists treating one patient harbors risks. Agreements on diagnostic and re-treatment criteria would help to improve network performance and outcomes.
authors.affiliation: Augenabteilung Sankt-Gertrauden Krankenhaus, Paretzer Strasse 12, 10713, Berlin, Germany. joachim.wachtlin@sankt-gertrauden.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Wachtlin
authors.affiliation: Augenklinik Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ringwald
authors.affiliation: Facharzt für Augenheilkunde, Augentagesklinik, Flemmingstraße 8 / Haus 9, 09116, Chemnitz, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Maulhardt
authors.affiliation: Novartis Pharma GmbH, Roonstr.25, 90429, Nürnberg, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Pohl
authors.affiliation: Novartis Pharma GmbH, Roonstr.25, 90429, Nürnberg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Wiedon
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007391:International Cooperation; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000072163:Ophthalmologists; D011446:Prospective Studies; D000069579:Ranibizumab / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab
keywords: Anti-vascular endothelial growth factor (VEGF); Germany; Neovascular age-related macular degeneration (nAMD); Non-interventional study; Physicians’ networks; Ranibizumab