Design and use of vignettes to investigate referral decision-making by optometrists

Parkins, David; Shah, Beju; Benwell, Martin J; Evans, Bruce J. W.; Edgar, David F

doi:10.1016/j.optom.2020.09.004

Cited by 2 publications

(1 citation statement)

References 21 publications

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“…However, research using computerised vignettes reveals no significant effect of optometric training on referral management decisions. 37 Generic advice in CPD will always lack the relevance of real cases and it seems likely that the best approach to raising the standard of optometric referrals is for those referrals to receive replies (Figure 2). In this way, the optometrist can take account of the ophthalmologist's opinion when they next consider referring a patient with a similar clinical presentation.…”

Section: Comparison With Previous Workmentioning

confidence: 99%

Referrals from community optometrists to the hospital eye service in England

Evans

Edgar

Jessa

et al. 2020

Ophthalmic Physiologic Optic

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Purpose In the UK, most referrals to the hospital eye service (HES) originate from community optometrists (CO). This audit investigates the quality of referrals, replies, and communication between CO and the HES. Methods Optometric referrals and replies were extracted from three practices in England. If no reply letter was found, the records were searched at each local HES unit, and additional replies or records copied. De‐identified referrals, replies and records were audited by a panel against established standards to evaluate whether the referrals were necessary, accurate and directed to the appropriate professional. The referral rate (RR) and referral reply rate (RRR) were calculated. Results A total of 459 de‐identified referrals were extracted. The RR ranged from 3.6%–8.7%. The proportion of referred patients who were seen in the HES unit was 63%–76%. From the CO perspective, the proportion of referrals for which they received replies ranged from 26%–49%. Adjusting the number of referrals for cases when it would be reasonable to expect an HES reply, RRR becomes 38%–62%. Patients received a copy of the reply in 3%–21% of cases. Referrals were made to the appropriate service in over 95% of cases, were judged necessary in 93%–97% and were accurate in 81%–98% of cases. The referral reply addressed the reason for the referral in 93%–97% and was meaningful in 94%–99% of cases. The most common conditions referred were glaucoma, cataract, anterior segment lesions, and neurological/ocular motor anomalies. The CO/HES dyad (pairing) in the area with the lowest average household income had the highest RR. Conclusions In contrast with the Royal College of Ophthalmologists/College of Optometrists joint statement on sharing patient information, CO referrals often do not elicit a reply to the referring CO. Replies from the HES to COs are important for patient care, benefitting patients and clinicians, and minimising unnecessary HES appointments.

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Section: Comparison With Previous Workmentioning

confidence: 99%

Referrals from community optometrists to the hospital eye service in England

Evans

Edgar

Jessa

et al. 2020

Ophthalmic Physiologic Optic

View full text Add to dashboard Cite

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Referrals from community optometrists to the hospital eye service in Scotland and England

Shah

Edgar

Khatoon

et al. 2021

Eye

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Objectives This audit assesses communication between community optometrists (COs) and hospital eye service (HES) in Scotland and England. Methods Optometric referrals and replies were extracted from six practices in Scotland and England. If no reply was found, replies/records were copied from HES records. De-identified referrals, replies and records were audited against established standards, evaluating whether referrals were necessary, accurate and directed to the appropriate professional. The referral rate (RR) and referral reply rate (RRR) were calculated. Results From 905 de-identified referrals, RR ranged from 2.6 to 8.7%. From COs’ perspective, the proportion of referrals for which they received replies ranged from 37 to 84% (Scotland) and 26 to 49% (England). A total of 88–96% of referrals (Scotland) and 63–76% (England) were seen in the HES. Adjusting for cases when it is reasonable to expect replies, RRR becomes 45–92% (Scotland) and 38–62% (England) with RRR significantly greater in Scotland (P = 0.015). Replies were copied to patients in 0–21% of cases. Referrals were to the appropriate service and judged necessary in ≥90% of cases in both jurisdictions. Accuracy of referral ranged from 89 to 97% (Scotland) and 81 to 98% (England). The reply addressed the reason for referral in 94–100% of cases (Scotland) and 93–97% (England) and was meaningful in 95–100% (Scotland) and 94–99% (England). Conclusions Despite the interdisciplinary joint statement on sharing patient information, this audit highlights variable standard of referrals and deficits in replies to the referring COs, with one exception in Scotland. Replies from HES to COs are important for patient care, benefitting patients and clinicians and minimising unnecessary HES appointments.

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Design and use of vignettes to investigate referral decision-making by optometrists

Cited by 2 publications

References 21 publications

Referrals from community optometrists to the hospital eye service in England

Referrals from community optometrists to the hospital eye service in England

Referrals from community optometrists to the hospital eye service in Scotland and England

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