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Per O Lundmark, Knut Luraas; Results from a 3-year prospective survey of referrals and medical reports in optometric practices in Norway: The effect of education on referrals and diagnostic conformity. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5246.
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© ARVO (1962-2015); The Authors (2016-present)
The increasing need for primary eye care in an ageing population implicates an augmented role of optometrists. The primary objective of this survey was to investigate the rate of referrals and returning medical reports between optometrists and other health care professionals in Norway. Secondary objectives were to investigate the conformity of diagnoses in referrals and medical reports, and the use of diagnostics drugs. The effect of education was investigated in post-hoc analyses.
This study was a prospective survey administered on the Internet between Nov 2014 and Dec 2017. Optometrists in private practice were eligible. Participants registered data for up to 1 year, incl. examinations and the use of ophthalmic diagnostic drugs; referrals; and medical reports. Analyses of diagnostic conformity were based on a conversion key of WHO diagnostic codes (ICD-10, ICPC-2) provided by the Norwegian Directorate of eHealth.
Included were 83 optometrists (F:50, mean age 40.7 yrs) with old and later educational background. There were 71,402 registered examinations (59.6% general, 28.8% contact lens, 11.6% auxiliary). Diagnostic drugs were used in 4.7% of these and in 16.0% of the exams that resulted in a referral. There were 2,605 registered referrals to ophthalmologists (97.0%), general practitioners (1.7%) and others (1.3%), corresponding to one referral every 4.7th person workday. Referral rate was higher for optometrists with older education than BSc or MSc (p<0.01). Top 3 referred diagnoses were cataract (34.6%), glaucoma (11.0%) and eye/adnexa disease (10.2%). There were 1,561 returned medical reports of which 1,242 could be linked to registered referrals. Diagnostic conformity was observed in 77.6% of these (73.4% for primary diagnoses) and was positively correlated with the level of education (p<0.05). Over-referrals was the most frequent cause of diagnostic non-conformity (≈1/4 of cases).
Norwegian optometrists refer sparsely and mainly to ophthalmologists. They use diagnostic drugs mostly in relation to referrals. Optometrist with an older education tend to refer more often, however, the diagnostic conformity between referrals and medical reports is high and appears to increase with the level of education. The findings support an augmented role of optometrists in Norwegian eye care.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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