Diagnostic Correlation between General Practitioners and the Ophthalmologist in the Management of Eye Diseases.

OBJECTIVES

To determine the accuracy of diagnosis of ophthalmic disorders as well as the adequacy of referral of patients with ophthalmic disorders for specialist eye care by the general practitioners (GP).

MATERIALS AND METHODS

This was a hospital-based descriptive study. Patients selected by systematic random sampling at the General Out-Patient Department (GOPD) of a tertiary hospital were evaluated by the ophthalmologist after they had been independently assessed by the General Practitioners. Diagnoses and referral decisions of the GP were compared with those of the ophthalmologist using Kappa Statistics.

RESULTS

A total of 382 patients were studied while 22 GPs participated in the study. Ocular disorders were found by the ophthalmologist in 112 (29.3%) patients while the remaining 270 (70.7%) were normal . Only 36 (32.1%) of those with ocular disorders had a diagnosis of ocular disorders by the General Practitioners. A correct diagnosis was made by the GPs for 18 (16.1%) patients (k=0.102, p =0.001); and the highest diagnostic agreement was obtained for conjunctivitis (k=0.464, P= 0.001). No patient with posterior segment disorder was diagnosed by the GPs. Majority (81%; k = 0.616, p=0.001) of referrals were in agreement with expected referral decision. However, 28 (25.0%) under-referrals and 16 (19.0%) over-referrals were noted.

CONCLUSION

About one-third of all the patients assessed had an ocular disorder, but the general practitioners detected these disorders only one-third of the time; a correct diagnosis of ocular disorders was made in only 16.1%, while no posterior segment disease was diagnosed. Wrong referral decisions were made in up to one-third of patients. Regular update courses for general practitioners on ophthalmic evaluation will help address these observed deficiencies.