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  • PCP Familiarity and Compliance With Guidelines for Eye Exams

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, February 2023

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    Moustafa et al. explored the degree of familiarity that primary care physicians (PCPs) possess in regard to the Acad­emy’s Preferred Practice Pattern (PPP) guidelines on the frequency of com­prehensive eye examinations. They also looked at PCP opinions and practices pertaining to counseling and referring of patients for eye exams. They found that the levels of familiarity and com­pliance varied widely.

    For this research, a survey to be completed anonymously was emailed to clinicians who had earned an MD, DO, physician assistant (PA), or nurse practitioner (NP) degree. Residents with an MD or DO were included. The survey was designed to be self-admin­istered electronically. Its overarching domains were knowledge of the 2015 PPP guidelines regarding comprehensive eye exams, attitudes toward the guide­lines, and counseling/referral practices for eye exams. Also included were five clinical scenarios for which respondents noted when the patient should see an eye specialist.

    Of the 336 PCPs invited, 216 completed the survey (response rate, 64.3%). Only 10.6% of PCPs could state some of the guidelines, and nearly 64% were completely unaware of them. In regard to counseling patients about compre­hensive eye exams, 15.4% “always” did so, 48.1% “usually” did so, and 36.5% replied “seldom” or “never.” With regard to patients with diabetes, nearly 91% of PCPs correctly referred those with type 2 diabetes for a comprehensive eye exam at the time of diagnosis, and 77.8% of PCPs prematurely referred patients with newly diagnosed type 1 diabetes. Approximately one in seven PCPs would refer a patient with family history of glaucoma only if visual or other ocular symptoms developed.

    Overall, PAs and NPs were most likely to recommend unnecessary comprehensive eye exams for low-risk individuals (p = .009). Relative to other providers, residents counseled patients less often (p = .003) and were less likely to be familiar with the practice guidelines (p = .026) or to recommend appropriate follow-up for patients with a family history of glaucoma (p = .004).

    The primary care workforce is a key partner in accurately identifying patients who need specialized eye care. Boosting awareness of practice guide­lines among PCPs may help improve the referral process, said the authors.

    The original article can be found here.