Abstract
Purpose:
To better understand the care for diagnosed glaucoma patients provided by optometrists (OD's). Since little data exist about patient reported outcomes (PRO's) among patients of OD's, we sought to characterize if and how PRO's change over time among glaucoma patients cared for by community based OD's as part of a randomized controlled trial (RCT).
Methods:
As part of a RCT to assess the value of patient involvement and technology based decision aids on the content of glaucoma care in the community setting, we measured NEI-VFQ, SF-12, EQ-5D, and patient satisfaction (CAHPS) through telephone interviews. Survey data was obtained from 678 patients of 66 OD's at baseline, 531 patients of 60 OD's at year 1, and 450 patients of 60 OD's at year 2. Because the randomization was at the OD level, (based on the same assignment for all participating OD's in a practice to avoid cross-contamination at a practice site), we analyzed PRO's at the level of the OD.
Results:
At baseline, there were no differences in SF-12 (PCS and MCS), EQ-5D, overall satisfaction on the CAHPS, or VFQ-composite or subscale scores, other than a better score on the VFQ mental health subscale in the intervention arm (mean of 73.4) compared to the control arm (70.4)(p=0.04).. At year 1, intervention arm PRO's were significantly better in the mental health component of the SF-12 (57.8 vs. 55.8, p =0.003), the VFQ ocular pain subscale (90.5 vs. 85.9, p =0.03), the VFQ mental health suscale (73.7 vs. 69.7, p=0.02), and the VFQ role limitations subscale (92.7 vs. 87.7, p=0.02). However, by year 2, there were no significant differences in PRO's. Overall, the average patient showed high levels of satisfaction throughout the study (mean of 9.4 to 9.5 on a 0 - 10 scale), relatively good visual function on the VFQ-composite (mean of 84 to 87), and more physical limitations on the SF-12 (PCS of 44 to 47) but less mental health limitations (MCS of 55 to 58).
Conclusions:
Patients who receive glaucoma care from community-based optometrists report being highly satisfied with their care over 2 years, with relatively stable VFQ, SF-12 and EQ-5D scores. However, these PRO's need additional analysis relative to the process quality of care and examination data (including visual field data) that was collected through chart abstraction as part of this study.
Keywords: 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower •
466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials