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A.C. Lee, C.M. Santiago–Turla, G. McGwin, Jr., A.L. Coleman, H.D. Jampel, R.P. Mills, P.P. Lee; Conformance with the Preferred Practice Pattern for Glaucoma: Survey of the American Glaucoma Society . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4406.
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Clinical practice guidelines have gained increasing prominence in helping guide the delivery of quality health care. The use of clinical vignettes in surveys has been shown to be a valuable and useful technique to assess process quality of care in other areas of medicine. In this analysis, we compare self–reported care patterns for patients with primary open angle glaucoma by members of the American Glaucoma Society with the American Academy of Ophthalmology’s Preferred Practice Pattern (PPP).
A mail survey was administered to members of the American Glaucoma Society. Of 414 surveys sent, 190 were completed (response rate 46%). Conformance was measured by assessing self–reported care responses to clinical vignettes for new patient and follow–up care with the recommendations of the PPP.
In the care of new patients, respondents reported performing an average of 58% (standard deviation [SD], 19%) of recommended history and exam elements. In initial history taking 91% would inquire about family history, but only 4% reported assessment of the impact of visual function on activities of daily living. For ocular examination, 60% would check pupils, 85% would perform gonioscopy, and 57% would obtain a visual field on the first visit. In the care of follow–up patients, respondents reported performing an average of 53% of recommended history and exam elements (SD, 19%). Problems with glaucoma medications were elicited by 71%, but only 16% would inquire about the frequency and time of last medications.
Responses to vignettes in a clinical care survey indicate that significant opportunities exist to enhance care relative to recommended care patterns, even among glaucoma specialists. This is similar to the results of other studies using chart reviews to measure process quality of care, but additional validation of the vignette methodology will be useful.
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