Abstract
Purpose:
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
Methods:
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.
Results:
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.
Conclusions:
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
Keywords: 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower •
465 clinical (human) or epidemiologic studies: systems/equipment/techniques •
466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials