Abstract
Abstract: :
Purpose: The primary care physician plays an important role in the identification and timely referral of high-risk patients into the care of an ophthalmologist. The ability of primary care residents to evaluate and refer patients in need of ophthalmic care was assessed in 1999 and compared to the knowledge base of residents in 2002. Methods: A survey was distributed to 1203 residents in family practice and internal medicine programs in the Baltimore-Washington area. Questions were designed to assess knowledge, referral patterns, and subjective appraisal of ophthalmic training. Results: In 1999, 263 surveys were completed, and 103 were completed in 2002. Comparing results from the 1999 and 2002 surveys, 47% vs. 32% identified an increased risk of glaucoma in African-Americans, 25% vs. 14% were unable to identify intraocular pressure as a risk factor, 76% vs. 67% correctly identified family history of glaucoma as a risk factor, 52% vs. 26% routinely asked their patients about family history, 57% vs. 45% were unable to identify a normal cup-to-disc ratio. In 1999, 55% routinely performed direct ophthalmoscopy during an exam, while only 30% feel competent to do so. In 2002, 18% performed direct ophthalmoscopy and 9% felt competent. 37% vs. 28% of the residents felt their training in ophthalmology was adequate, 49% vs. 49% felt their training was weak, and 15% vs. 22% felt they received little or no training. Conclusions: These data suggest that primary care residents have inadequate training in ophthalmic care and feel unprepared to serve as the primary gatekeepers for common eye diseases. Although many medical schools and residency programs have placed a greater emphasis on primary care in the setting of managed care, this has not translated into an improvement in ophthalmic knowledge over the past 4 years. There is clearly a need for improved curricula in medical school and residency programs in the detection and treatment of common blinding eye diseases in the community.
Keywords: clinical (human) or epidemiologic studies: hea • clinical (human) or epidemiologic studies: tre • learning