Bridging the Gap: Improving the Efficacy of Referrals from ...€¦ · Standard Procedure for Low...
Transcript of Bridging the Gap: Improving the Efficacy of Referrals from ...€¦ · Standard Procedure for Low...
A. Bertolet, J. Adelsberger E. Humphreys, I. Kreydin, H. Woodward, J. Zebrowski
New England College of Optometry, Boston, MA
Bridging the Gap: Improving the Efficacy of Referrals from Primary Care Optometrists to Low Vision
Specialists
Introduction
Methods
Results and Findings Solutions
References
Acknowledgements
47%
10%
16%
16%
11%
Primary Care Responses: What is your
Definition of Low Vision?
Any visual impairment that limits a
patient's normal visual function
BCVA 20/40
BCVA 20/60
BCVA 20/100
BCVA 20/20087%
0% 13%
0%
0%
Low Vision Specialist Responses: What is your
Definition of Low Vision?
Any visual impairment that limits a
patient's normal visual function
BCVA 20/40
BCVA 20/60
BCVA 20/100
BCVA 20/200
63%
37%
Primary Care Optometrists: Are you Aware
that some Insurances Cover Low Vision Exams
and Devices?
Yes No
12%
88%
Low Vision Specialists: Are Patients Aware of
Resources Available to them upon their First
Visit?
Yes No
14
7
10
6
5
3
1
Primary Care Optometrists: What Resources
do you Provide Low Vision Patients?
53%
26%
16%
5%
Primary Care Optometrists: What is the
Standard Procedure for Low Vision Patients?
Referral to Low Vision Specialist
Provide Care Yourself
Low Vision Specialist on Staff
Nothing
1. Marinoff R. Referral patterns in low vision: a survey of mid-south
tri-state eye care providers. J of Behavioral Optometry. 2012; 23(1):
1-15.
2. Matti A, et al. Access to low vision rehabilitation services: barriers
and enablers. Clinical and Experimental Optometry. 2011 Mar; 9(2):
181-186.
3. Wittich W, Canuto A, Overbury O. Overcoming barriers to low-
vision rehabilitation services: improving the continuum of care. Can
J Opthalmol. 2013 May; 48(6): 463-467.
4. Enhanced Vision’s Introduces “Transformer USB” – An Intuitive
Magnifying Solution with Laptop USB Connectivity. Enhanced Vision
News. 2010 Nov. Web. Accessed April 7, 2014.
<http://www.enhancedvision.com/enhanced-vision-news-
media/enhanced-vision-news/enhanced-visions-introduces-
transformer-usb-an-intuitive-magnifying-solution-with-laptop-usb-
connectivity.html>
5. How Can The Lighthouse Low Vision Clinic Help You? Lighthouse
Louisiana. Web. Accessed October 31, 2014.
<https://lighthouselouisiana.org/low-vision-clinic/how-can-lvc-help-
you>
We would like to thank Dr. Richard Jamara for his
assistance in contacting low vision specialists, and Mr.
Michael Charron, Associate Executive Director of Member
Services of the Massachusetts Society of Optometrists for
his assistance in contacting primary care optometrists.
Thank you to NECO and the AAO for providing the
opportunity to present this work.
Based on this research, we propose three solutions for
the consideration of optometrists.
• Normalize a definition of low vision as any visual
impairment that impedes functionality.
Discrepancies in the definition of low vision can lead to
patients not being referred despite the fact that they
can benefit from low vision therapy.
• Provide resources for primary care optometrists
regarding insurance coverage for low vision
appointments and devices. These could be in the
form of a fact sheet, informational email from MSO or
other optometric organization, or Continuing Education
course.
• Provide advice for increasing the efficacy of
referrals to a low vision specialist. This may include
calling on behalf of the patient to book the appointment,
providing more information about the potential
advantages of low vision therapy, and providing
information regarding insurance benefits so that
patients know if their visits will be covered.
• Two IRB approved surveys were created to compare
the opinions and practices of primary care optometrists
and low vision specialists:
• Primary Care Optometrists at the Massachusetts
Society of Optometry (MSO).
• Low vision specialists at optometry schools across
the country.
• Questions within the surveys inquired about low vision
definitions and available resources, as well as referral
and intake processes.
For the survey sent to members of MSO, 21 responses were recorded. Of these, two responses
were discarded as the respondents did not identify their primary work as primary care optometry.
Additionally, 8 responses were recorded from the 22 low vision specialists from optometry schools
in the US.
OUR PURPOSE is to provide
potential solutions to help primary care
optometrists refer low vision patients
more effectively in order to make an
efficient and timely transition from
primary care optometry to low vision
specialty care.
Figure 1: Magnifying solution with laptop connectivity
via USB port 4
One in four Americans over the age of forty
experiences some level of vision impairment
(AOA).1
The services provided by low specialists can
significantly improve their patients’ quality of life by
improving emotional well-being and independence in
day to day life.2
• Management can include prescribing and training
patients to use low vision optical devices (telescopes,
video-magnification devices, or stand magnifiers) to
maximize remaining vision, as well as referring to
occupational therapists.1,3
Despite the clear advantages, there remains a
discrepancy between the number of patients who
would benefit from low vision services and utilization
of these services.2
• Optometrists play an important role in connecting low
vision patients with low vision specialists.
• Specific issues cited previously focus on potential low
referral rates by optometrists to low vision specialists
and poor patient education of services available to
them.
• Previous research focuses primarily on patient barriers
to accessing low vision services: driving distances,
depression, willingness, etc.
47% of the Primary Care Responders chose “any
visual impairment that limits a patient’s normal
visual function.” The rest of the responses vary
between 20/40 through 20/200
87% of the Low Vision Specialists considered
“any visual impairment that limits a patient’s
normal visual function” as being low vision.
Low vision is considered a numerical cut off in the minds of a many of the primary care
optometrists whereas most low vision specialists consider it to be based on the patient’s daily
function – with differing opinions, all patients are not provided the same options
37% of primary care optometrists are unaware that
some insurances cover low vision exams and
devices.
•Primary care optometrists may not have
adequate knowledge about insurance coverage
needed to effectively counsel patients.
53% of primary care optometrists state that their
standard of care is to refer patients to a low vision
specialist while 26% say they will provide care
themselves.
• This decreases referral rates from primary care
optometrists, so some patients may not be
effectively treated
14 out of 19 primary care optometrists referred to
a low vision specialist, while 10 also provided optical
devices or information about optical devices.
• Only 3 primary care optometrists cited that
they provide insurance information to patients
88% of Low vision specialists claim their patients
are unaware of resources available to them when
they present for consultation
There is a disconnect between the patients’ understanding and the resources that the primary
care optometrists believe that they are offering.