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Jason Cheng, Laura Beltran-Agullo, Graham Trope, Yvonne Buys; Quality of Referral Letters to a Tertiary Glaucoma Unit and adherence to Glaucoma Guidelines. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4405.
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To assess the quality of glaucoma referral letters in relation to current guidelines and discuss the impact of inter physician communication quality in glaucoma management
Prospective review of 200 consecutive referral letters to a tertiary glaucoma unit. Letters were assessed for content in relation to the Canadian Ophthalmological Society glaucoma guidelines and also other information that a specialist would require to make a glaucoma management decision.
Out of 200 referrals, 92(46%) came from ophthalmologists, 84(42%) from optometrists, 20(10%) from family physicians & 4 from other. The most common reason for referral was for suspected diagnosis of glaucoma (37%) followed by assessment for progression/further treatment (25%), angle closure assessment (17%), transfer of care (10%), second opinion (6%) and secondary glaucoma (4%). Of the 73 referrals for suspected diagnosis of glaucoma, 34 were from optometrists, 28 from ophthalmologists & 11 from others. The 34 optometry referrals provided visual acuity (VA)(97%), intraocular pressure (IOP)(100%), disc assessment(88%) and visual fields (VF)(13%) much more frequently than the 28 referrals from ophthalmologists, whom 46% (p<0.001) provided VA, 64% (p<0.001) provided IOP, 75% (p=0.2) disc assessment and only 7% (p=0.006) enclosed visual fields. Of the 50 referrals for progression assessment or for consideration of surgery, 45 (90%) included the current IOP, 34 (68%) disc assessment, 42 (84%) current glaucoma therapy, 16 (32%) included a current VF and 8 (16%) provided previous VFs. Only 12 (24%) of these referrals included more than 10 of the 14 suggested information points in the Canadian Ophthalmological Society glaucoma guidelines, and 34% included less than 8 of the 14 points. Overall, 74% of the referral letters were deemed legible.
Our study shows that glaucoma referral letters rarely contain all the relevant information and ophthalmologists are particularly at fault. Previous visual fields and pre-treatment IOP can be invaluable in management planning and progression analysis. 34% of glaucoma referrals from optometrists and ophthalmologists contain half or less of the suggest information recommended by the Canadian Ophthalmological Society. Over a quarter of the referrals were at least partially illegible. Further education and perhaps implementation of a proforma may improve referral letter quality
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