Geographic Availability To Optometry Services Across Canada: Mapping Distribution, Need And Self-Reported Use

Abstract

Background: This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision care services. Methods: Optometrist locations were gathered from provincial regulatory bodies. A geocoding approach converted descriptive data into geographic coordinates. Utilizationof vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013-2014 question regarding self-reported contacts with optometrists or ophthalmologistsproviders. Data from the 2016 Statistics Canada census were used to create three population 'need' subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Optometrist-to-population ratios, expressed as number of providers per 10,000 people at the health region level, were then calculated.Three classes: low (< -1.5 standard deviation (SD); -1.5 to -0.50 SD), moderate (-0.5 to 0.5 SD), and high (0.50 to 1.5 SD, > 1.5 SD) were used as a cut-off for demonstrating distributionof optometrists across health regions). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Results: A total of 5,959 optometrists working across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada and they are predominantly concentrated in urban areas. The mean ratio of optometrists across Canada was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services. Conclusion: This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availabilityrelative to "supply" and "need" factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.