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Paul P. Lee, William Rafferty, Sanjay Asrani, David Lobach, David Matchar, Shelley Dutton, Gerald McGwin, Jr.; Documentation of Glaucoma Care Among Community-Based Optometrists. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1413.
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Given the growing numbers of patients with open-angle glaucoma (OAG) associated with the aging of populations around the world, understanding the opportunities to improve care among providers of glaucoma care is essential to take advantage of the findings of clinical trials. Because little data exists about the nature of eye care for OAG provided by non-MD providers, we sought to characterize the documentation of optometric care of patients with open-angle glaucoma(OAG) in the community setting.
As part of a randomized controlled trial (RCT) to assess the value of patient involvement and technology based decision aids on the quality of glaucoma care in the community setting, we abstracted the charts of more than 680 patients cared for by 58 optometrists. In this study, we analyzed the abstraction results at baseline for care provided prior to the initiation of RCT study activities. We compared the care documented in the charts of the optometrists to the recommendations of the American Optometric Association's (AOA) guidelines for care for patients with OAG. Abstractions were performed by two trained and validated abstractors in the optometrists' office so that as complete a data collection as possible could be obtained.
Analysis of the first 450 of the more than 680 charts demonstrates variation in the documentation of initial assessment care elements. While elements of the history were generally well documented, with documentation of ocular surgery history the lowest at 40% and visual function and quality of life the next lowest at 61%, documentation of examination elements were more variable. Among the elements with low rates of documentation were: blood pressure documentation in 10%, gonioscopy in 10%, pupil reactivity in 20%, and corneal pachymetry in 11%. Elements with high rates of documentation included visual acuity at 96%, intraocular pressure in 95%, and the optic nerve appearance in more than 87%. The stage of glaucoma was not specified in nearly 60% of charts.
The results of baseline chart abstraction demonstrate significant variation and opportunities for greater conformance relative to professional guidelines. These results are generally similar in nature to those for prior analyses of care with ophthalmologists. We anticipate that the greater use of electronic health records in the future may help improve the content and documentation of care for glaucoma and will be able to assess the added impact of interventions in our RCT to improve care.
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