Primary eye care in the United Kingdom : describing access, utilization, patients' preferences and quality care

Objective: To describe access, utilisation, patients' preferences and quality of primary eye care. Methods: Three studies were carried out (1) Project one: This was a cross sectional study of consultations for eye conditions in seven general practices in Norfolk and Waveney, located in rural, urban and inner city areas. Anonymised data about age, sex, Read codes, and ophthalmic prescriptions were extracted from electronic records using MIQUEST. All patients with an ophthalmic (that is, eye- related) diagnosis or prescription between 1 st May 2008 and 30th April 2009 were identified. The annual period prevalence, consultation and prescription for eye conditions rates in each practice's population were estimated, and directly standardised using the age and sex distribution of the population of East of England. (2) Project two: This was a cross sectional postal questionnaire survey of the patients with eye conditions identified in project one. The questionnaire included questions on: utilisation of eye care during the previous year, patients' preferences for sources of eye care and indicators of quality of care for selected sight-threatening conditions. The relationships between these variables and individuals' socio-demographic characteristics were investigated. (3) Project three: investigated primary care of ophthalmic conditions recorded in the General Practice Research Database (GPRD). It had two components. The first component included all patients who had any ophthalmic Read code recorded during one year. The second component included all patients who had a Read code recorded for the following chronic sight-threatening conditions during five years: glaucoma, diabetic retinopathy, age related macular degeneration (ARMD) and giant cell arteritis. For both components, rates of consultations, prescriptions and referrals were estimated, and their possible associations with patients' demographic characteristics were investigated. Poisson regression analysis was also performed. Results: Project one: Of a total practice population of 60739,4646 (7.7%) patients had either an ophthalmic condition or prescription or both, of which 3089 (5.1 %) people had an eye condition and 3328 (5.5%) had ophthalmic prescriptions. More females than males had an ophthalmic consultation or obtained a prescription except in preschool children who had more ophthalmic consultations than females. Project two: The response rate was 46.3% (568/1228). The main findings were that patients had a clear preference for seeing their GP for treatment of a red eye which appeared to be associated with geographical proximity to the GP's practice. Females tend to seek eye care more than males. There are also results on quality of care which suggests disparity in care received by deprivation levels. Project three: Overall prevalence of consultation was 13.4%, more females than males. Incidence of consultation for four eye condition (Glaucoma, ARMD, diabetic retinopathy and giant cell arteritis. Prevalence was highest for conjunctivitis 3.11 % in component two, the annual incidence rates of glaucoma, ARMD, diabetic retinopathy and giant cell arteritis were respectively, 9.3, 7.0 , 4.8 and 2.0 per 10,000 population. Conclusion This study provides an original overview of the burden of ophthalmic conditions and of utilisation, access, patients' preferences for sources of eye care and quality of primary eye care in the United Kingdom, Norfolk and Waveney in particular. Such evidence is essential for planning future improvements in eye care in the United Kingdom's National Health Service.EThOS - Electronic Theses Online ServiceGBUnited Kingdo