Integrating Care: The Primary Care Provider’s Role in Age-Related Macular Degeneration in Eastern Maine

Objectives: To assess general patient knowledge of age-related macular degeneration (AMD), including risk factors, early signs, treatment options, and low-vision resources. We also aimed to assess primary care provider practice patterns including early detection, timely referral to ophthalmology, and management after diagnosis of AMD. Methods: A 20-point patient questionnaire was distributed to all adult patients at check-in by front office staff at the Center for Family Medicine office in Bangor, ME. Additionally, a looping waiting room slideshow and informational exam room flyer were created for patient education. A 10-point online questionnaire was distributed to residents and faculty at the Center for Family Medicine and three other local primary care offices. A care management summary document was distributed to residents and faculty at each practice. Results: Our sample included 46 adult patients and 23 primary care providers. 18% of patients reported adequate or expert knowledge of early signs and symptoms; 50% reported poor to no knowledge. Similarly, 18% of patients reported adequate knowledge of risk factors; 50% reported poor to no knowledge. 64% of patients did not know what AMD was, but 74% wish they knew more about the disease. Patients with AMD in one or both eyes, or who have family members with AMD, were more likely to be knowledgeable of signs, symptoms and risk factors. 70% of providers routinely ask about vision at Well-visits. However, 43% of providers somewhat or completely disagree that they can comfortably perform a fundus exam. 52% of providers somewhat or completely disagree that they can comfortably perform and interpret the Amsler grid test. 39% of providers wish they knew more about the risk factors for AMD, while 34% considered themselves to have adequate or expert knowledge of the risk factors. 43% of providers wish they knew more of early signs and symptoms of AMD, while 53% considered themselves adequate or expert. Conclusions and Recommendations: Our study suggests that knowledge of AMD risk factors, signs and symptoms are lacking in the general adult population. However, the vast majority of patients desire to know more about the disease. While the majority of primary care providers inquire about vision at well-visits, the majority of providers felt that their ability to perform funduscopic exams and Amsler grid testing were inadequate. Additionally, the majority of providers expressed inadequate knowledge of risk factors, early signs, and referral guidelines; subsequently, an even higher percentage or providers expressed a desire to know more. Furthermore, most providers lacked knowledge of low-vision behavioral modifications and community resources to support patients with existing AMD. This demonstrates the value and need for additional AMD education for primary care providers and the general patient population.https://scholarworks.uvm.edu/fmclerk/1163/thumbnail.jp