Kaleem Mona A, West Sheila K, Im Lily T, Swenor Bonnielin K
*Department of Ophthalmology, University of Maryland †Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD.
J Glaucoma. 2017 Feb;26(2):e115-e120. doi: 10.1097/IJG.0000000000000600.
To identify characteristics of ophthalmologists and practices who refer glaucoma patients to low vision services (LVS).
An online survey was distributed to members of the American Glaucoma Society. The survey queried demographics of responders and their clinical practices, criteria and barriers to referral to LVS. Survey responders were categorized as high referrers if they reported referring >5 patients to LVS and low referrers if they referred ≤5. χ and Fischer exact tests were used to compare characteristics between high and low referrers. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals and determine factors associated with referrer status.
High referrers to LVS tended to have >10 patients per month who had already seen a low vision provider (53% vs. 10%, P<0.001), reported following the American Academy of Ophthalmology's Preferred Practice Pattern (PPP) recommendations for LVS referrals (38% vs. 18%, P=0.011), and expressed satisfaction with their current referral practices (86% vs. 70%, P=0.049). In the fully adjusted model those who followed PPP were 2.5 times more likely to report being a high referrer as compared with a low referrer (95% confidence interval, 1.1-5.3). However, only 22% of ophthalmologists reported following these guidelines in their practice. The number of years in practice, practice location or type, volume of patients seen each week, and distance to a low vision clinic were not associated with referral.
Familiarity with PPP guidelines may positively influence LVS referral practices.
确定将青光眼患者转诊至低视力服务（LVS）的眼科医生及其诊疗实践的特征。
向美国青光眼协会成员发放在线调查问卷。该问卷询问了受访者的人口统计学信息及其临床诊疗情况、转诊至LVS的标准和障碍。若受访者报告转诊至LVS的患者>5例，则被归类为高转诊者；若转诊≤5例，则为低转诊者。采用χ检验和费舍尔精确检验比较高、低转诊者之间的特征。使用逻辑回归分析计算比值比和95%置信区间，并确定与转诊者状态相关的因素。
转诊至LVS的高转诊者每月往往有>10例已看过低视力服务提供者的患者（53%对10%，P<0.001），报告遵循美国眼科学会低视力服务转诊首选实践模式（PPP）建议的比例更高（38%对18%，P=0.011），且对其当前的转诊实践表示满意（86%对70%，P=0.049）。在完全调整模型中，遵循PPP的人报告为高转诊者的可能性是低转诊者的2.5倍（95%置信区间，1.1 - 5.3）。然而，只有22%的眼科医生报告在其诊疗实践中遵循这些指南。从业年限、执业地点或类型、每周看诊患者数量以及与低视力诊所的距离与转诊无关。
熟悉PPP指南可能对低视力服务转诊实践产生积极影响。
