If patients must choose between traveling for an appointment with a distant government-insured ophthalmologist, paying out-of-pocket for an appointment with a local optometrist, or visiting a government-insured, local primary care physician (PCPs) or emergency department (ED) physician, they are more likely to choose the PCP or ED, according to a Canadian study in Clinical Optometry. In the province of Prince Edward Island in Canada, where the study was conducted, optometric services are not government-insured, while services provided by other eye care providers are.

For each of the 5 regions of Prince Edward Island (Charlottetown, Stratford, Queens & Kings, Summerside, and Prince), the investigators calculated how many diagnoses of ocular conditions from 2010 to 2012 were conducted by PCPs and EDs. They compared that number with ocular diagnoses from all health care providers in those years. They excluded patients who had previously received an ocular diagnosis, and they only included patients’ most recent eye care service that occurred in each study year.

Residents of Charlottetown, the region with the most ophthalmologists, had significantly more ocular diagnoses than residents in Prince, Summerside and Queens & Kings, but not significantly more than residents in Stratford, the region closest to it.


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In 2010, residents in Prince, the region furthest from Charlottetown, had nearly twice the number of ocular diagnoses from PCPs (22.4%) and EDs (8.8%) compared with residents of Charlottetown (13.5%, 4.1% respectively) (P <.05). In 2010 and 2011, Prince residents were more likely than those in any other region to obtain ocular diagnoses from their PCPs or EDs. Prince residents obtained new diagnoses in 2011 and 2012 most frequently from PCPs or EDs (2011: 28.0% in Prince, 18.6% in Charlottetown). In 2010, patients living in Prince received the most ocular diagnoses from PCPs (3.0% (95% CI 2.8-3.3%) and EDs (3.8% (95% CI 3.4-4.3%)) compared with those living in Charlottetown (1.6% (95% CI 1.5-1.8%); 1.8% (95% CI 1.5-2.1%).

“Owing to differences in the levels of training and available equipment for eye examinations among PCPs, ED physicians and ophthalmologists, residents outside of Charlottetown and its nearby region Stratford may not have received the same standard of eye care as those residing in these 2 regions,” according to investigators. “Distance barriers to see a government-insured ophthalmologist and costs associated with seeing an optometrist likely contributed to the observed disparities in eye care.”

“Funding all optometric services” may reduce the need to travel to ophthalmologists and costs for ED visits, according to investigators. This can also enable PCPs and EDs to focus on more patients more appropriate to their respective settings. 

Limitations of the study include unknown validity of diagnostic codes from PCPs and EDs and the frequency of use of private or employer insurance.

Reference

Jeon W, Trope GE, Buys YM, et al. The effect of government-uninsured optometric services on the use of primary care providersClin Optom. 2021;13:119-128. doi:10.2147/OPTO.S303087