Abstract
Purpose: :
Prior work has shown that patients, especially those 65 and older, underutilize eye care. Even patients with sight-threatening disorders such as diabetes go to regular primary care visits but do not receive recommended eye care. Finding ways to better reach these patients could result in a decrease in advancing eye disease and avoidable blindness. With little published to date on how primary care providers make referral decisions for eye care, we sought to obtain data from primary care providers (PCPs) about their perceptions and suggestions as to how to enhance appropriate utilization of eye care.
Methods: :
After a literature review, we conducted structured interviews with each of 3 PCP types [physician (MD), physician assistant (PA), and nurse practitioner (NP)]. The results of the review and interview data were then used to create scripts used in 4 focus groups (2 MD, 1 PA, and 1 NP) with community-based PCPs who practice in North Carolina. Focus groups ranged in size from 4 to 8 providers. Content analysis (including N*udist) was performed to identify key concepts.
Results: :
Content analysis of transcripts from interviews and focus groups revealed several barriers to referral to eye care, such as PCP time constraints, difficulty in scheduling eye care visits, insufficient communication with eye care providers (ECPs), various patient-specific factors, and lack of follow-up. Interestingly, all three PCP types would consider providing more eye care, but only with appropriate reimbursement. MDs tended to want an assistant to provide these services while PAs and NPs were more interested in additional training to provide services themselves. Suggestions made in all groups on ways to increase eye care utilization included: implementing electronic record systems to facilitate easier scheduling and communication between providers; encouraging better follow-up by ECPs; and providing direct communication routes to eye care clinics.
Conclusions: :
PCPs desire change(s) in the current referral-to-eye-care system. Better communication between PCPs and ECPs, timely follow-up with patients, and easier scheduling of eye care appointments were common themes. Implementing specific suggestions, such as modernizing medical record systems, may help to increase eye care utilization among patients at high risk for advancing eye disease and vision loss.
Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: systems/equipment/techniques