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Jessie Huang, Michael Yapp, Katherine Masselos, Michael Kalloniatis, Barbara Zangerl; Impact of referral letter content on management of glaucoma patients and suspects in collaborative care. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5247.
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© ARVO (1962-2015); The Authors (2016-present)
Collaborative care models have been developed to address a projected increase in demand for eye care due to growing and aging populations. Good communication between health practitioners facilitates effective collaboration and efficient management of patients. Referral letters are the first point of contact and an essential part of inter-professional communication. We investigated the content of referral letters to a collaborative clinic in Australia, with respect to standard clinical examination findings necessary for glaucoma diagnosis and their impact on patient management.
Optometrist-initiated referral letters for patients who attended the Glaucoma Management Clinic (Centre For Eye Health, Sydney, Australia) between March 2015 and October 2016 were reviewed retrospectively. Descriptive statistics were used to report referral content and management outcomes. Chi-square test was applied to identify differences between patient groups according to prior diagnosis and management outcome and also referrer groups based on therapeutic endorsement.
Of 100 referrals, 51 were for treatment-naïve patients and 49 for patients with established glaucoma or treated ocular hypertension. Intraocular pressure was the most frequently reported clinical parameter (90%) followed by optic disc findings (65%, of those 26% had OCT) and visual field results (61%, 52% attached a copy). 41% of referrals included all three parameters. Optometrists were significantly more likely to include optic disc (p<0.001) or visual field (p=.016) findings for treatment-naïve patients compared to patients with an established diagnosis. Referrals made by therapeutically endorsed optometrists (n=51) were more likely to report historical or systemic risk factors (p<0.001) than referrals from their non-endorsed colleagues (n=49). Referral outcomes for treatment-naïve patients included initiation of glaucoma treatment (37%), ongoing surveillance (43%) and discharge (20%); inclusion of visual field and optic disc findings were not significantly associated with the referral outcome (p=0.87 and 0.67, respectively).
Optometrist-initiated referral letters requesting glaucoma assessment frequently omit pertinent examination data. Although, the exclusion of examination findings did not influence patient management, missing data may impact efficient delivery of collaborative care between practitioners.
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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