Quality and targeting of new referrals for ocular complications of diabetes from primary care to a public hospital ophthalmology service in Western Sydney, Australia
Belinda Ford
A B E , Lisa Keay A C , Blake Angell A , Stephanie Hyams D , Paul Mitchell B D , Gerald Liew B C D and Andrew White B C D
+ Author Affiliations
- Author Affiliations
A The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW 2042, Australia.
B Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia.
C School of Optometry and Vision Science, Faculty of Science, UNSW Sydney, Sydney, NSW 2052, Australia.
D Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia.
E Corresponding author. Email: bford@georgeinstitute.org.au
Australian Journal of Primary Health 26(4) 293-299 https://doi.org/10.1071/PY20084
Submitted: 14 April 2020 Accepted: 4 June 2020 Published: 14 July 2020
Abstract
Patients with diabetes require regular examination for eye disease, usually in primary care settings. Guidelines recommend patients with at least moderate non-proliferative diabetic retinopathy (NPDR) be referred to an ophthalmologist for treatment; however, poorly targeted referrals lead to access blocks. The quality of new referrals associated with diabetes to a public ophthalmology service in Sydney, New South Wales, Australia, were assessed for referral completeness and targeting. A cross-sectional audit of medical records for new patients referred to Westmead Hospital Eye Clinic in 2016 was completed. Completeness of medical and ophthalmic information in referrals and subsequent patient diagnosis and management in 2016–17 was recorded. Sub-analyses were conducted by primary care referrer type (GP or optometrist). In total, 151 new retinopathy referrals were received; 12% were sent directly to a treatment clinic. Information was incomplete for diabetes status (>60%), medical (>50%) and ophthalmic indicators (>70%), including visual acuity (>60%). GP referrals better recorded medical, and optometrists (37%) ophthalmic information, but information was still largely incomplete. Imaging was rarely included (retinal photos <1%; optical coherence tomography <3%). Median appointment wait-time was 124 days; 21% of patients received treatment (laser or anti-vascular endothelial growth factor) at this or the following encounter. Targeting referrals for ocular complication of diabetes to public hospitals needs improvement. Education, feedback and collaborative care mechanisms should be considered to improve screening and referral in primary care.
Additional keywords: chronic eye disease, primary care screening, referral refinement, streamlined services.
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