University College London Interaction Centre (UCLIC), UCL, London, UK.
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL, Institute of Ophthalmology, London, UK.
Ophthalmic Physiol Opt. 2023 Sep;43(5):1255-1277. doi: 10.1111/opo.13183. Epub 2023 Jul 3.
In the UK, ophthalmology has the highest number of outpatient appointments within the National Health Service. False-positive referrals from primary care are one of the main factors contributing to the oversubscription of hospital eye services (HESs). We reviewed the accuracy of referrals originating from primary care optometrists and contributing factors, such as condition type and years since registration.
Of the 31 studies included in the review, 22 were retrospective analyses of referrals and appointments at the HES. Eight were prospective studies, and one used online clinical vignettes. Seven assessed the accuracy of referrals for all ocular conditions. The remaining studies focused on glaucoma (n = 11), cataracts (n = 7), emergency conditions (n = 4), neovascular age-related macular degeneration (n = 1) and paediatric binocular vision (n = 1). The diagnostic agreement for suspected emergency ocular conditions was the lowest, with only 21.1% of referrals considered to require urgent attention in one study. For glaucoma, the first-visit discharge rate was high (16.7%-48%). Optometrist referral accuracy was overall 18.6% higher than General Medical Practitioners'; however, the two mainly referred different ocular conditions. Female optometrists made more false-positive referrals than males (p = 0.008). The proportion of false positives decreased by 6.2% per year since registration (p < 0.001).
There was significant variation in referral accuracy across different ocular conditions, partly due to differences when defining accurate referrals. Optometrists working in primary care are generally more limited in their resources than the HES. Thus, choosing the cautious option of referral when they are unsure could be in the patients' best interests. The possible effect of increased use of advanced imaging on referrals requires evaluation. Although interventions such as refinement schemes have been put in place, these vary across regions, and their approaches such as virtual referral triaging may reduce unnecessary HES face-to-face appointments and promote communication between primary and secondary care.
在英国，眼科是国民保健制度（NHS）中预约门诊数量最多的科室。基层医疗保健中出现的假阳性转诊是导致医院眼科服务（HES）预约过度的主要因素之一。我们回顾了基层医疗保健视光师转诊的准确性及其影响因素，如疾病类型和注册年限。
在纳入审查的 31 项研究中，有 22 项是对 HES 转诊和预约情况的回顾性分析。其中 8 项为前瞻性研究，1 项使用在线临床病例。有 7 项评估了所有眼部疾病转诊的准确性。其余的研究集中在青光眼（n=11）、白内障（n=7）、急症（n=4）、新生血管性年龄相关性黄斑变性（n=1）和儿童双眼视觉（n=1）。疑似紧急眼部疾病的诊断一致性最低，在一项研究中，只有 21.1%的转诊被认为需要紧急关注。对于青光眼，首次就诊的出院率较高（16.7%-48%）。视光师的转诊准确率总体上比全科医生高 18.6%；然而，两者主要转诊的眼部疾病不同。女性视光师的假阳性转诊比男性多（p=0.008）。自注册以来，每年假阳性的比例减少了 6.2%（p<0.001）。
不同眼部疾病的转诊准确性存在显著差异，部分原因是准确转诊的定义不同。与 HES 相比，在基层医疗保健工作的视光师的资源通常更为有限。因此，当他们不确定时，选择谨慎转诊的方式可能符合患者的最佳利益。需要评估增加使用先进成像技术对转诊的影响。尽管已经实施了诸如改进计划等干预措施，但这些措施在不同地区有所不同，其方法，如虚拟转诊分诊，可能会减少不必要的 HES 面对面预约，并促进初级和二级保健之间的沟通。
