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M. M. Olivier, J. C. Washington; Glaucoma Screening in a Resident Clinic of High Risk Patient Referrals From Primary Care Physicians. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2509.
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African American’s are at higher risk of developing glaucoma and are ideal candidates for inclusion in screening. A targeted method of risk factor assessment that primary care physicians could use to identify high risk patients would help streamline the referral process to ophthalmology and get patients screened/evaluated in a more timely and efficient manner. Barriers associated with timely appointments in the general eye clinic at John H. Stroger, Jr., Hospital of Cook County include long wait times for the next available appointment (up to 1 year), high no show rates for existing appointments, tracking positive diagnosis and an expanding number of external referral sources.
Data from 835 patients seen in screening clinic at between 10/24/2004 and 08/10/2006 was collected and analyzed using a quasi-experimental cross-sectional study design. Screening services were aimed at referral pattern evaluation and diagnosing and treating glaucoma earlier. The sensitivity of specific risk factors, including sex, race, visual field defects on FDT, increased vertical C/D ratio, history of diabetes and hypertension, a positive family history of glaucoma, and elevated IOP were assessed. Primary analysis of the data used a logistic regression model to identify the effect of screening on presence or absence of glaucoma and MANOVA for testing of multiple dependent variables, while accounting for their inter-correlations.
The inclusion criteria significantly improved screening effectiveness (compared to standard referral patterns which book patient’s up to one year later) and therefore early identification of glaucoma patients based on referral collaboration with primary care physicians using these specific indicators (p <.05). The screening identified 42.6% of African Americans, 35.9% of Hispanics, and 6.4% whites as having clinically significant glaucoma from the total population based on FDT results and at least three other indicators that were significant in all three major ethnic groups identified.
Vision-screening programs can serve as an effective means for the early detection of glaucoma in high-risk populations referred from primary care physicians and is more likely to yield positive results. This program serves as a model for similar programs. From a public health perspective, the findings support the need for triangulation in screening, incorporating a needs assessment, observation, and quantitative data for optimal programmatic impact . Prescreening patients with quick referral into a established eye clinic reduces the economic cost with earlier detection.
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