Research

A survey of the patterns of referral from community optometrists to medical practitioners, and an assessment of the nature and quality of communication between professions regarding referral outcomes

Tina Romanay

Several studies have been published investigating aspects of referral made by community optometrists.  Hobley et al found that during a study period, 2.86% of patients were referred and 1.08% had notifications written about them. By far the greatest number of referrals was to an ophthalmologist via the patient’s GP (67%).  Referrals to the GP only accounted for 26%, and 7% were referrals directly to an ophthalmologist.

Port et al revealed the major causes of referral were cataract, glaucoma, fundus changes, headaches/migraine/eye pain and lowered visual acuity. Harrison et al, found that he most common cause for referral was visual loss or disturbance, followed by suspected glaucoma, abnormalities of binocular vision, disorders of eyelids or ocular adnexa, and red eye.

In order to receive feedback from ophthalmologists, the optometrist should obtain patient consent for disclosure of medical information on the GOS 18 referral form. Whittaker et al investigated the optometrist’s use of the GOS 18 form and surmised that the GOS 18 form could be used more effectively and ophthalmologists could also be responsible for obtaining patient consent, to aid communication.

The studies quoted above date from a period (pre 2000) before the change in the rules regarding the management of patients by optometrists. There is a need for a comprehensive review of referral patterns of optometrists in the light of the changed legislation and the coming move into therapeutic prescribing by optometrists.

Further investigations can be carried out to determine whether patient consent is a barrier to exchange of information between optometrists and medical practitioners. Analysis of the GOS 18 form in this study will determine whether the GOS 18 form should be modified. In addition, analysis will also reveal if increased communication between professionals would improve the quality of future referrals.

The aims of the research are:

To determine the percentage of referrals and reasons for referral to medical practitioners from community optometric practice

  1. To determine the method of referral (e.g. GOS 18, letter or other)
  2.  To evaluate the percentage and quality of replies received from medical practitioners regarding the outcome of referral.
  3.  To determine the views of patients, GPs and ophthalmologists regarding the communication of referral outcomes to optometrists.
  4.  To analyse the quality of referrals to general practice and the hospital eye service from community optometrists
  5.  To determine the barriers to the feedback of referral outcomes from medical practitioners and to establish whether the current GOS 18 form could be modified to improve communication between optometrists and medical practitioners.