The relationship between unwarranted variation in optometric referrals and time since qualification

Autor: David F Edgar, Bruce J W Evans, David J. Parkins, Martin J Benwell
Rok vydání: 2018
Předmět:
Zdroj: Ophthalmicphysiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists). 38(5)
ISSN: 1475-1313
0275-5408
Popis: Purpose: To investigate variation in optometric referral decision-making and the influence of experience and continuing education and training (CET).\ud \ud Methods: To gain insight into unwarranted variation in referral activity in the UK: (1) triage data were audited to investigate source of referral, provisional diagnosis, and outcome; (2) an online system was developed to present two sets of ten vignettes, designed to avoid prompting answers. Participating optometrists completed ten pre-CET vignettes, recording their tests and management decisions. The main group of participants chose whatever CET they wished over a six-month period and then completed another ten post-CET vignettes. A second group of newly-qualified optometrists completed the vignettes before and after a CET course intervention, followed by a third group of pre-registered optometrists with an intervention of six-months experience of their pre-registration year.\ud \ud Results:\ud The audit identified 1951 optometric referrals and 158 optometrists (211 referrals were from GP practices), with 122 of the 158 optometrists making fewer than ten referrals. Two newly-qualified optometrists generated 12.5% of the total referrals in the audit (N = 2162). Many suspect glaucoma referrals were based on a single suspect measurement resulting in a high discharge rate after community review, as did referrals for certain fundus-related appearances for which no treatment was indicated.\ud \ud The intervention of gaining CET points appeared to have no significant impact (p = 0.37) on referral decision-making, although this part of the study was underpowered. Self-selection bias was confirmed in the main group. When the main group and newly-qualified practitioners were compared, the number of referrals was negatively associated with time since qualification (p = 0.005). When all twenty referral decisions were compared, all optometrists referring more than ten vignette patients came from a group of newly-qualified practitioners up to two years post qualification. Pre-registered optometrists generally referred more appropriately than newly-qualified. Upon qualification, there was a significant increase in the number of sight tests undertaken per day (p =
Databáze: OpenAIRE
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