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W. Rafferty, D. Matchar, J. Macri, D. Lobach, G. McGwin, M. Hunt, P. Lee; Resource Utilization of Personnel in the Eye Care of Patients With Diabetes Mellitus . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4413.
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The growing US and global prevalence of diabetes mellitus (DM) will create challenges to the health and eye care delivery systems, especially given current issues of access and quality of care. While optometrists and ophthalmologists both see patients with DM, little is known about the work effort used by eye care providers in caring for a patient with DM. As part of an ongoing community–based randomized trial investigating the usefulness of technological innovations in enhancing the use of evidence–based diabetes eye care, we assessed baseline work time effort for eye care with DM patients.
98 enrolled provider participants completed a baseline work effort survey for 4 clinical vignettes corresponding to standard evaluation and management visit levels 2 through 5 (for both new and established patients). Providers estimated the time that they and, if applicable, a clinical assistant, such as a technician, would spend with the patient. Responses were also assesed for association with provider and practice characteristics..
All patient visit times increased steadily as the level of complexity of the visit increased, from an average of 14.2 (+8.4) minutes for the eye care provider at a level 2 new visit to 29.6 (+13.1) minutes for a level 5 complexity new patient visit. Clinical assistant times also rose, from 12.2 (+5.7) to 16.2 (+7.8) minutes respectively. While optometrists spent more time with the patient, ophthalmologist practices used more assistant time, reducing the difference in total times spent by the patient in receiving care. Similar patterns were found for follow–up visits. The higher the numbers of patients seen per week, the less time the provider would tend to spend with the patient, though no difference was generally found for assistant time.
Greater patient complexity elicits greater work effort as measured by self–reported time on the part of eye care providers. It appears that, from a resource utilization standpoint, use of technicians can complement the work effort for eye care for patients with DM. The impact of doing so on quality of care and patient outcomes will be assessed as part of the ongoing trial.
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