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Crystal Cheung, Nima Noordeh, Chloe Gottlieb; A national survey of Canadian ophthalmologists’ knowledge and application of uveitis management guidelines. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2932.
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To assess current awareness and clinical practice among Canadian ophthalmologists of published uveitis treatment guidelines. Also assessed was frequency of applications to the public health system for immunomodulatory therapy (IMT), and identification of primary prescribers.
A 25-item questionnaire with clinical practice-related patient scenarios was sent to 759 practicing Canadian ophthalmologists. The published guidelines referenced are of an international panel of uveitis experts (Jabs et al., 2000). Six questions assessed demographics, including year of residency completion, presence of uveitis specialists during residency, and fellowship training in uveitis or a related sub-specialty. Seven questions assessed application of the guidelines to clinical scenarios, and twelve assessed referral patterns and success of obtaining coverage for IMT.
Of 144 respondents, twelve (8.3%) were uveitis specialists. Uveitis specialists were present during residency for 45.1% of respondents. Correct responses reporting 1) awareness and 2) utilization of the guidelines was 60.4% in both cases. 75.1% appropriately identified instances where referral to a specialist for IMT is needed. Recent graduates (completed residency between 2001 and 2012) referred patients to uveitis specialists (55.3%) less frequently than earlier graduates. Recent graduates also managed uveitis patients more frequently with intravitreal or periocular steroids (48.4%) than those graduated before 1980 (10.5%), who reported more usage of systemic therapy. 88.9% of respondents submitted less than five IMT funding applications to the public health system yearly, while 4.9% reported prescribing IMT themselves, rather than referring to other specialists.
Self-reported awareness and application of uveitis treatment guidelines were not associated with practice patterns following the guidelines. Identification of patients requiring IMT in the clinical practice scenarios was less frequent than self-reported rates of referral to specialists for management of IMT. Few applications are made for IMT and the majority are sent by non-ophthalmologists. This suggests the need for further education of ophthalmologist about uveitis treatment guidelines and for more ophthalmologists trained to manage uveitis.
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