政府未承保的验光服务对初级保健提供者使用情况的影响。

The Effect of Government-Uninsured Optometric Services on the Use of Primary Care Providers.

作者信息

Jeon William, Trope Graham E, Buys Yvonne M, Wedge Richard, El-Defrawy Sherif, Chen Qi-Sheng, Jin Ya-Ping

机构信息

Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.

出版信息

Clin Optom (Auckl). 2021 Apr 21;13:119-128. doi: 10.2147/OPTO.S303087. eCollection 2021.

DOI:10.2147/OPTO.S303087

PMID:33911907

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8071696/

Abstract

INTRODUCTION

Eye care in many countries is provided by optometrists, ophthalmologists, primary care providers (PCPs, including family physicians and pediatricians) and emergency department (ED) physicians. In the province of Prince Edward Island (PEI), Canada, optometric services are not government-insured, while services provided by other eye care providers are government-insured. Clinics of optometrists, PCPs and ED physicians are widely distributed across the island. Clinics of ophthalmologists however are concentrated in the capital city Charlottetown.

PURPOSE

To investigate if more patients visited government-insured PCPs and EDs for eye care when local optometric services are government-uninsured and government-insured ophthalmologists are potentially distant.

METHODS

From PEI physician billing database, we identified all patients with an ocular diagnosis from 2010-2012 using International Classification of Diseases, 9th Revision (ICD-9) codes. The utilization of government-insured PCPs and EDs in five geographical regions was assessed utilizing patients' residential postal code. Of the five regions, Prince was the region farthest from the capital Charlottetown.

RESULTS

Compared to utilization of government-insured PCPs for ocular diagnoses in Charlottetown (13.5% in 2010, 95% confidence interval [CI] 12.9-14.0%), the utilization in Prince (22.4% in 2010, 95% CI 21.7-23.1%) was nearly double (p<0.05). The utilization of ED physicians for ocular diagnoses was similarly double in Prince (8.8%, 95% CI 8.3-9.3%) versus Charlottetown (4.1%, 95% CI 3.8-4.5%). The utilization of ophthalmologists however was significantly lower in Prince (43%, 95% CI 41.4-42.9%) versus Charlottetown (56.3%, 95% CI 55.6-57.1%). Similar trends remained throughout 2010-2012.

CONCLUSION

When optometric services are government-uninsured and government-insured ophthalmologist services are geographically distant, ocular patients utilized PCPs and ED physicians more frequently. Due to different levels of training and available equipment for eye examinations among PCPs, ED physicians and optometrists, the quality of eye care and cost-effectiveness of increased use of PCPs and ED physicians for ocular management warrant further investigation.

TRIAL REGISTRATION

Not applicable.

摘要

引言

在许多国家，眼科护理由验光师、眼科医生、初级保健提供者（包括家庭医生和儿科医生）以及急诊科医生提供。在加拿大爱德华王子岛省（PEI），验光服务不在政府保险范围内，而其他眼科护理提供者提供的服务则在政府保险范围内。验光师、初级保健提供者和急诊科医生的诊所遍布全岛。然而，眼科医生的诊所以集中在省会夏洛特敦。

目的

调查当当地验光服务不在政府保险范围内且政府保险的眼科医生可能距离较远时，是否有更多患者前往有政府保险的初级保健提供者和急诊科进行眼科护理。

方法

我们从PEI医生计费数据库中，使用国际疾病分类第9版（ICD - 9）编码，识别出2010 - 2012年所有有眼部诊断的患者。利用患者的居住邮政编码评估五个地理区域内有政府保险的初级保健提供者和急诊科的利用率。在这五个区域中，王子区是距离首都夏洛特敦最远的区域。

结果

与夏洛特敦有政府保险的初级保健提供者对眼部诊断的利用率（2010年为13.5%，95%置信区间[CI] 12.9 - 14.0%）相比，王子区的利用率（2010年为22.4%，95% CI 21.7 - 23.1%）几乎翻倍（p < 0.05）。王子区急诊科医生对眼部诊断的利用率（8.8%，95% CI 8.3 - 9.3%）与夏洛特敦（4.1%，95% CI 3.8 - 4.5%）相比同样翻倍。然而，王子区眼科医生的利用率（43%，95% CI 41.4 - 42.9%）显著低于夏洛特敦（56.3%，95% CI 55.6 - 57.1%）。在2010 - 2012年期间，类似趋势一直存在。