Impact of Geographic Density of Eye Care Professionals on Eye Care among Adults with Diabetes

Chou, Chiu Fang; Zhang, Xinzhi; Crews, John E.; Barker, Lawrence; Lee, Paul P.; Saaddine, Jinan B.

doi:10.3109/09286586.2012.722244

Cited by 34 publications

(22 citation statements)

References 45 publications

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“…3 Prior studies have demonstrated that the likelihood of adults with diabetes receiving annual dilated eye examinations is reduced in areas with a lower geographic density of eye care professionals. 4 Currently, there is a lack of published literature on the unavailability of on-call ophthalmologists for emergency eye care.…”

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confidence: 99%

Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

2016

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IMPORTANCE Determining the perceived supply and potential demand for teleophthalmology in emergency departments could help mitigate coverage gaps in emergency ophthalmic care. OBJECTIVE To evaluate the perceived current need for and availability of ophthalmologist coverage in California emergency departments and the potential effect of telemedicine for ophthalmology triage and consultation. DESIGN, SETTING, AND PARTICIPANTS Surveys were remotely administered to 187 of the 254 emergency departments throughout California via the telephone and Internet from June 30 to September 23, 2014. Emergency department nurse managers and physicians from all emergency departments listed in the California Office of Statewide Health Planning and Development database were individually surveyed to assess facility characteristics and resources as well as the perceived usefulness of teleophthalmology consultation. Data analysis was conducted from June 30, 2014, to March 11, 2015. MAIN OUTCOMES AND MEASURES Perceived availability of ophthalmology consultation coverage and perceived effect of telemedicine ophthalmology consultation at each facility. RESULTS Of the 187 emergency departments surveyed, 18 of 37 rural facilities (48.6%) reported availability of emergency ophthalmology coverage, compared with 112 of 150 nonrural facilities (74.7%). Rural facilities reported a mean (SD) of 23.72 (14.15) miles between the facility and referral location, while nonrural facilities reported a mean of 4.41 (10.23) miles (19.3% difference). On a scale of 1 to 5 (where 1 signifies very low value and 5 signifies very high value), 124 of 187 nurse managers (66.3%) and 80 of 121 physicians (66.1%) rated teleophthalmology as having high or very high value for triage purposes. The most frequently cited potential advantage of emergency teleophthalmology was assistance in patient triage and immediate real-time electronic communication, and the most frequently cited potential disadvantages were unknown cost of contracting and maintenance and concern that eye trauma might make photographs or videos less conclusive. CONCLUSIONS AND RELEVANCE Availability of ophthalmology coverage for emergency eye care is limited, particularly among rural emergency departments in California. Surveyed emergency department nurse managers and physicians indicated moderately high interest and perceived value for a teleophthalmology solution for remote triage and consultation. Overall, the study suggests that teleophthalmology could play a role in mitigating coverage gaps in emergency ophthalmic care and could be further investigated through similar studies in other regions.

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confidence: 99%

Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

2016

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“…Further research should examine whether individual-level characteristics such as age, income, education, and other relevant contextual variables are associated with use of eye care services, as has been done in research examining vision care providers in the United States among adults with diabetes. [43] There are several contextual factors in relation to vision care services that this research does not examine, such as funding policies and insurance availability. [44] It is important to note that this research only considered geographical barriers and not cost barriers.…”

Section: Resultsmentioning

confidence: 99%

“…In previous studies on eye care services/utilization, different socio-demographic characteristics have been found to be related to distribution of optometry services. A further analysis of the Canadian Longitudinal Study on Aging [24] identi ed disparities in the utilization of eye care services in Canada with less educated populations (less than bachelor's degree) and those with lower income less likely to use these services. For example, in an analysis of the Canadian Longitudinal Study on Aging, Aljied, Aubin, Buhrmann [38] reported that older age and income are critical factors for visual impairment.…”

Section: Resultsmentioning

confidence: 99%

Geographic Availability To Optometry Services Across Canada: Mapping Distribution, Need And Self-Reported Use

Shah

Milosavljevic

Bath

2020

Preprint

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Abstract Background: This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision services.Methods: Optometrist locations were gathered from provincial regulatory bodies. Optometrist-to-population ratios (i.e. the number of providers per 10,000 people at the health region level) were then calculated. Utilization of vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013-2014 question regarding self-reported contacts with optometrists or ophthalmologists. Data from the 2016 Statistics Canada census were used to create three population ‘need’ subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Each variable was converted into three classes (i.e., low, moderate, and high) using a standard deviation (SD) classification scheme where ± 0.5SD from the mean was considered as a cut-off. Three classes: low (< -0.5SD), moderate (-0.5 to 0.5SD), and high ( > 0.5SD) were used for demonstrating distribution of each variable across health regions. Results: A total of 5,959 optometrists across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada; they are predominantly concentrated in urban areas. The national mean ratio of optometrists was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services.Conclusion: This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availability relative to “supply” and “need” factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.

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“…Residents of US with low densities of eye care professionals, for example, have reduced likelihood of vision service access, even among those with insurance. [24] Further, rural and remote residents face additional challenges due to longer travel distances to receive vision care. [25] To date, there has been little work in Canada that has focused solely on investigating the distribution of optometry services relative to potential need and use.…”

Section: Introductionmentioning

confidence: 99%

Geographic Availability To Optometry Services Across Canada: Mapping Distribution, Need And Self-Reported Use

Shah

Milosavljevic

Bath

2020

Preprint

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Background: This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision care services. Methods: Optometrist locations were gathered from provincial regulatory bodies. A geocoding approach converted descriptive data into geographic coordinates. Utilizationof vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013-2014 question regarding self-reported contacts with optometrists or ophthalmologistsproviders. Data from the 2016 Statistics Canada census were used to create three population 'need' subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Optometrist-to-population ratios, expressed as number of providers per 10,000 people at the health region level, were then calculated.Three classes: low (< -1.5 standard deviation (SD); -1.5 to -0.50 SD), moderate (-0.5 to 0.5 SD), and high (0.50 to 1.5 SD, > 1.5 SD) were used as a cut-off for demonstrating distributionof optometrists across health regions). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Results: A total of 5,959 optometrists working across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada and they are predominantly concentrated in urban areas. The mean ratio of optometrists across Canada was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services. Conclusion: This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availabilityrelative to "supply" and "need" factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.

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Impact of Geographic Density of Eye Care Professionals on Eye Care among Adults with Diabetes

Cited by 34 publications

References 45 publications

Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

Geographic Availability To Optometry Services Across Canada: Mapping Distribution, Need And Self-Reported Use

Geographic Availability To Optometry Services Across Canada: Mapping Distribution, Need And Self-Reported Use

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