Eye Care (eye + care)

Distribution by Scientific Domains

Selected Abstracts

Practice Characteristics and HMO Enrollee Satisfaction with Specialty Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy

Josť J. Escarce
Background. The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential. Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR). Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices. Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction. Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction. Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction. [source]

The content of optometric eye examinations for a young myope with headaches

Rakhee Shah
Abstract Background:, A recent review found standardised patient (SP) methodology to be the gold standard methodology for evaluating clinical care. We used this to investigate the content of optometric eye care for a young myopic patient with headaches suggestive of migraine. Methods:, We recruited 100 community optometrists who consented to be visited by an unannounced actor for an eye examination and to have that eye examination recorded. The actor received extensive training to enable accurate reporting of the content of the eye examinations, via an audio recording and a checklist completed for each clinical encounter. The actor presented as a 20-year-old student seeking a private eye examination and complaining of symptoms suggestive of migraine headaches. The results of each clinical encounter were recorded on a pre-designed checklist based on evidence-based reviews on headaches, clinical guidelines and the views of an expert panel of optometrists. Results:, The presence of headache was detected in 98% of cases. Eight standard headache questions were considered to be the gold standard for primary care headache investigation. Although none of the optometrists asked all of these questions, 22% asked at least four of the eight questions. Sixty-nine per cent of practitioners asked the patient to seek a medical opinion regarding the headaches. The proportion of the tests recommended by the expert panel that was carried out varied from 33% to 89% and the durations of the eye examination varied from 5 to 50 min. Conclusion:, SP encounters are an effective way of measuring clinical care within optometry and should be considered for further comparative measurements of quality of care. As in research using SPs in other healthcare disciplines, our study has highlighted substantial differences between different practitioners in the duration and depth of their clinical investigations. This highlights the fact that not all eye examinations are the same and that there is no such thing as a ,standard sight test'. We recommend that future optometric continuing education could usefully focus on migraine diagnosis and assessment. [source]

A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing role

Justin J. Needle
Abstract Purpose:, Recent changes in medicines legislation in the UK have broadened the opportunities for optometrists to use and supply therapeutic drugs. We set out to investigate the current therapeutic practice of UK optometrists and to elicit their views on an extended prescribing role. Methods:, Members of the College of Optometrists were invited via email to take part in an online survey. The survey questions covered four areas: mode of practice, proximity and relationship to other providers of eye care, scope of current therapeutic practice and future plans regarding prescriber training. Results:, Of the 1288 responses received (response rate 24%), over 90% were from optometrists working in community practice. Common, non-sight-threatening conditions were managed frequently or occasionally by between 69 and 96% of respondents. Blepharitis and dry eye were the most common (managed routinely by >70%). In terms of therapeutic agents used, large numbers of optometrists reported that they commonly supplied or recommended over-the-counter (non-prescription) drugs, particularly lubricants and anti-allergic agents. However, fewer respondents supplied antibiotics (only 14% supplying chloramphenicol or fusidic acid frequently). Overall, relatively few respondents (14%) expressed no interest in undertaking further training for extended prescribing, although several barriers were identified, including cost and time taken for training, lack of remuneration and fear of litigation. Conclusion:, Significant numbers of community optometrists are currently managing a range of common ocular conditions using a limited formulary. Enabling optometrists to train as independent prescribers will further develop this role, allowing greater use of their skills and providing patients with quicker access to medicines. [source]

Some possible longer-term ocular changes following excimer laser refractive surgery

Laura Oliveira-Soto
While the short- and medium-term refractive and acuity results of excimer laser refractive surgery may now be generally satisfactory, the relatively brief history of the procedures involved (around 10 years or less) means that those concerned with eye care must remain vigilant to the possibility of longer-term problems. This paper reviews some relevant studies of potential post-surgical effects, including imperfect corneal healing and recovery of innervation, reduced corneal sensitivity and dry eye problems, changes in corneal rigidity leading to slow refractive change, possibly misleading reductions in measured intraocular pressure, and retinal and vitreous pathology. [source]

The 75th anniversary of the World Council of Optometry: Seventy-five years of advancing eye care by optometrists worldwide

Damien P Smith PhD AM
SUMMARY Over 75 years, the World Council of Optometry has developed as an organisation with the mission and appropriate strategies to improve the quality of eye and vision care around the world, especially by advancing the delivery of that care by educated, regulated, primary care optometrists. However, WCO is unknown to most optometrists and ,international optometry' is not part of the optometric curriculum in our schools, just as it is rarely on the agenda of our professional associations. As a consequence, many optometrists do not understand the difficulties faced by their colleagues in other countries, in both clinical and political challenges. Australian optometrists are regulated by law, educated at state universities, eligible for service coverage by universal health insurance, able to detect disease in the eye using diagnostic agents and, in increasing numbers, able to treat disease in the eye with therapeutic drugs. However, this community standing and professional privilege, taken for granted by most Australian optometrists, cannot be exported. In fact, an Australian optometrist would be jailed in many countries around the world just for doing the ordinary clinical procedures that he or she does on every patient, by routine, day in and day out. All optometrists should feel ownership of WCO and all should have a commitment to its mission to facilitate the enhancement and development of eye and vision care by optometrists worldwide. Australian optometrists are already linked to WCO through their membership of Optometrists Association Australia, which is itself a longstanding and valued member of WCO. To prosper for a further 75 years, WCO needs continued global volunteerism and from those unable to directly participate, financial support through donations and sponsorship. [source]