Primary Care Provider Familiarity with Preferred Practice Patterns for Comprehensive Eye Examinations

Abstract

Purpose : The American Academy of Ophthalmology (AAO) developed Preferred Practice Pattern (PPP) guidelines to standardize the frequency of comprehensive eye exams (CEEs) for specific patient groups. These guidelines may benefit Primary Care Provider (PCPs), who often serve as patients’ only touchpoints with the healthcare system. However, PCPs’ familiarity with these guidelines is unclear. We surveyed PCPs’ familiarity and compliance with CEE guidelines, and whether these patterns varied according to practitioner training level, length of experience, or state.

Methods : We surveyed PCPs, primary care residents, physician assistants (PA), and nurse practitioners (NP) affiliated with two academic medical centers in Boston, MA, and Oklahoma City, OK, as well as a sample of private practice PCPs in Oklahoma. Respondents were given five clinical vignettes and asked to indicate when the patient should be referred for a CEE. Additional questions assessed participants’ familiarity with PPPs for CEEs, attitudes toward CEE guidelines, and perceived barriers to utilizing such guidelines. Groups were compared using chi-squared or Fisher’s exact tests.

Results : The response rate was 216/336 (64.3%). Around half of PCPs (48.1%) reported “usually” counseling patients regarding CEEs; 15.4% reported “always” doing so, while 36.5% reported “seldom” or “never”. Few PCPs (10.6%) were able to accurately describe specific guidelines, whereas two-thirds (63.9%) were unaware of their existence. OK-based PCPs reported greater familiarity with PPP guidelines than MA PCPs (p=0.02). Alignment with disease-specific PPPs varied considerably; a strong majority of PCPs (90.7%) correctly referred a type II diabetic at their time of diagnosis, but a similar majority (77.8%) inappropriately referred a newly-diagnosed type I diabetic. 13.4% of PCPs would not refer a young patient with family history of glaucoma until they developed visual symptoms. Compared to other providers, NPs/PAs were more likely to recommend unnecessary CEEs for low risk young adults (p=0.04), while residents counseled patients less frequently (p<0.01), were less likely to be aware of PPP guidelines (p=0.03), and less likely to properly recommend baseline exams.

Conclusions : PCPs’ familiarity with CEE guidelines is suboptimal. Targeted efforts to improve PCP guideline awareness may be especially well suited for residents and mid-level practitioners.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

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