Factors influencing accuracy of referral and the likelihood of false positive referral by optometrists in Bradford, United Kingdom

Abstract

AimsLevels of false positive referral to ophthalmology departments can be high. This study aimed to evaluate commonality between false positive referrals in order to find the factors which may influence referral accuracy.MethodsIn 2007/08, a sample of 431 new Ophthalmology referrals from the catchment area of Bradford Royal Infirmary were retrospectively analysed.ResultsThe proportion of false positive referrals generated by optometrists decreases with experience at a rate of 6.2% per year since registration (p < 0.0001). Community services which involved further investigation done by the optometrist before directly referring to the hospital were 2.7 times less likely to refer false positively than other referral formats (p = 0.007). Male optometrists were about half as likely to generate a false positive referral than females (OR = 0.51, p = 0.008) and as multiple/corporate practices in the Bradford area employ less experienced and more female staff, independent practices generate about half the number of false positive referrals (OR = 0.52, p = 0.005).ConclusionsClinician experience has the greatest effect on referral accuracy although there is also a significant effect of gender with women tending to refer more false positives. This may be due to a different approach to patient care and possibly a greater sensitivity to litigation. The improved accuracy of community services (which often refer directly after further investigation) supports further growth of these schemes.

Evaluation of a minor eye conditions scheme delivered by community optometrists

“…The average follow-up rate in similar ESS has been reported to be 22.13%,8 with individual schemes reporting rates between 6.3% and 56.3%;8–10 12 21 no data are available for the PEARS in Wales 11. HES referral rates for UK MECS schemes have been reported to average 19.3%;8 18.2% of patients accessing the PEARS were referred to the HES, a rate similar to the Lambeth and Lewisham MECS (18.9%).…”

“…Although the optometrists participating in the Lambeth and Lewisham MECS did not have a non-medical prescribing qualification, medication was supplied to 48.3% of first and follow-up visits; patients were referred to secondary care due to the seriousness of their condition and not as a result of a lack of prescribing rights, as might be the case elsewhere 21. Approximately a quarter of patients who needed a prescription were prescribed antibiotic drops, with ocular lubricants being the predominantly prescribed ocular medication.…”

“…21 Approximately a quarter of patients who needed a prescription were prescribed antibiotic drops, with ocular lubricants being the predominantly prescribed ocular medication. It has been reported that GPs may overprescribe ocular antibiotics, due to a number of factors, with patient pressure or inability to discriminate between viral and bacterial conjunctivitis being common reasons.…”

Quality indicators in a community optometrist led cataract shared care scheme

“…Our shared care model facilitates this approach by using the designated referral data from optometrists to triage patients into appropriate clinics. The quality of clinical referral via the direct referral pathway is generally much more detailed and relevant than NHS choose‐and‐book referrals, allowing for more efficient use of existing clinical resources and ensuring that the maximum number of patients are listed in just one preoperative clinical visit . Our direct referral form ( Figure ) illustrates an effective tool for capturing relevant clinical data in order to facilitate clinical triage.…”

The relationship between unwarranted variation in optometric referrals and time since qualification

“…Most patients seen by the hospital eye service (HES) are referred by optometrists . Optometrists are reported to generate more false‐positive referrals than general medical practitioners (GPs), although in referral research the false‐positive rate obtained depends on the definition of a false‐positive referral. There is variation in the quality and content of optometrists’ referral letters and the need for improvement for some practitioners has been indicated .…”