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P. M. O'Connor, K. Fotis, J. E. Keeffe; Patient Decision-Making in Eye Care Service Selection: Lessons From a New Model of Community-Based Eye Care Delivery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3242.
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To identify the key factors that determined patient decision-making in eye care service selection.
A new model of eye care service delivery was trialled by the Royal Victorian Eye and Ear Hospital (RVEEH) in Melbourne, Australia for patients with stable age-related macular degeneration (AMD), diabetic retinopathy (DR) and glaucoma. Eligible patients were offered the option of having on-going monitoring of their eye conditions by specific local urban and rural primary care providers (optometrists/general practitioners) rather than at the RVEEH, a tertiary hospital. Patients who used the community-based eye care were compared with those who remained at the RVEEH to determine the key factors that underpinned their respective decisions. Interviews were conducted with a sub-set of accepters and decliners. A combination of quantitative and qualitative methodologies was used.
One-hundred and seventy nine eligible patients were approached to participate (mean±SD age 69.9, ±11.9 years; 51% female). Of these, 103 accepted, 69 declined and 7 deferred their decisions. Among those interviewed (n=46), 83% self-reported having little or no difficulties with their vision; few either sought family advice before deciding (6%) or had any concerns about attending a local practitioner (10%). Transport-related factors (36%) and personal preference (25%) dominated the reasons why patients declined (n=69). Among interviewed accepters (n=37), 68% indicated that being individually approached by the RVEEH influenced their decision while 81% found it easier and substantially more timesaving to travel locally. Analysis of acceptance and decline rates by location showed a significant association between patients’ decisions and distance (X2=17.56; p=0.007) with higher acceptance rates evident for those located most distant from the RVEEH.
Transport-related factors played an important role in patient decision-making in eye care service selection. This has important implications for planning eye care service as distance and the travel logistics can be barriers or facilitators to service selection.
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