Biomedical subjects

K G Albrecht

Publications and source records attributed to K G Albrecht.

3 recordsLinked to original sources

PubMed1996

Glaucoma care and conformance with preferred practice patterns. Examination of the private, community-based ophthalmologist.

BACKGROUND: Practice guidelines are becoming more prominent in the provision of medical care. A previous study demonstrated a high rate of conformance with recommended patterns of care for patients with open-angle glaucoma in an academic, public clinic setting. This study seeks to examine conformance within the private, community-based setting in which the vast majority of healthcare is delivered. METHODS: One-hundred ninety-three charts (average, 24 charts each from 8 different practices) of patients who received diagnoses for at least 2 years of open-angle glaucoma were evaluated retrospectively for conformance with recommendations from the American Academy of Ophthalmology's Preferred Practice Pattern (PPP) for primary open-angle glaucoma. The criteria were evaluated in three areas: (1) the performance of specified examination steps at the initial visit; (2) the performance of specified examination steps at follow-up; and (3) the time interval between follow-up visits. RESULTS: In 56.4% of patients who had stable moderate to severe glaucomatous damage, documentation of examination findings on the initial visit ranged from 39.4% for a pupil examination to 100% for intraocular pressure. At the initial visit, visual fields were obtained or scheduled in 90.2% of eyes, gonioscopy was performed in 51.3%, and the disc/nerve fiber layer status was noted in 97.9%. On follow-up, 44% of patients had documentation concerning the status of their glaucoma, but only 23.3% of patients had an optic nerve head drawing or photograph within 15 months of the most recent visit. In addition, the authors found that 37.8% of patient charts had neither an optic nerve head drawing nor a photograph documented after the initial visit. Finally, although 92.2% of patients with glaucoma were scheduled for follow-up within the time intervals recommended by the PPP, patients with uncontrolled or unstable glaucoma were the least likely to be followed up within PPP-recommended time intervals. CONCLUSIONS: Chart reviews from private, community-based ophthalmologists show that some initial examination steps such as gonioscopy and pupil examination are performed to widely varying degrees. While patients are generally likely to be scheduled for follow-up within PPP-recommended intervals, patients with unstable glaucoma are the least likely to be so scheduled. In addition, the visual appearance of the optic nerve is recorded for a relatively low percentage of patients. Additional data are needed from other geographic areas and other practice settings and for other patterns of care to more fully assess provider behavior relative to PPPs.

Community Medicine↗

PubMed1994

Conformance with preferred practice patterns in caring for patients with glaucoma.

BACKGROUND: Practice guidelines are becoming more prominent in the provision of medical care. However, the limited data that exist suggests that conformance in ophthalmic care may be low. METHODS: A retrospective study of 120 charts of patients with open-angle glaucoma was conducted to evaluate conformance with recommendations from the American Academy of Ophthalmology's Preferred Practice Pattern for open-angle glaucoma. The criteria were operationalized for evaluation of three dimensions: (1) the performance of specified examination steps at the initial visit; (2) the performance of specified examination steps at follow-up; and (3) the time interval between follow-up visits. RESULTS: In a sample where 70% of patients had stable moderate to severe glaucomatous damage, documentation of examination findings on the initial visit ranged from 70% for a pupil examination to 100% for intraocular pressure. At the initial visit, visual fields were obtained or scheduled in 92% of eyes, gonioscopy in 85%, and the disc/nerve fiber layer status in 98%. On follow-up, 90% of patients had an optic nerve head drawing or photograph within 9 months of the most recent visit. Finally, 100% of patients were scheduled for follow-up within the time intervals recommended by the Preferred Practice Pattern. CONCLUSIONS: Unlike the situation with diabetic retinopathy and corneal ulcers, there appears to be a high rate of conformance with recommended patterns of care for patients with open-angle glaucoma in a public clinic setting. Additional data are needed from other practice settings and for other patterns of care to not only assess the quality of care but to help guide revisions in preferred practice patterns.

Follow-Up Studies↗

PubMed1994

The potential role of ophthalmology as an entry point to the healthcare system.

PURPOSE: To evaluate whether patients who receive ophthalmic care have other physicians and whether ophthalmologists can serve as a significant entry point to the healthcare system. METHODS: Two hundred fourteen patients at a tertiary care eye institute were surveyed regarding their non-ophthalmologist physicians. Demographic, medical, and other data also were collected through the survey. RESULTS: Twenty-eight percent of patients did not have a physician healthcare provider other than their ophthalmologist at their initial visit. Fifteen percent had no other physician, whereas 13% had one as a consequence of subsequent referral by the ophthalmologist. Even among those patients who were 40 years of age and older, 31% initially only had an ophthalmologist as their sole physician provider. Being older, female, and having Medicare, a Health Maintenance Organization membership, or private indemnity insurance were associated with a higher likelihood of having non-ophthalmologist physicians. CONCLUSIONS: These results suggest that a significant number of patients seeking eye care from an ophthalmologist have no other physician. These findings stress the need for eye care providers to have thorough medical education and clinical training. In addition, eye care may serve as a useful entry point into the healthcare system for a significant number of patients in the United States.

Adolescent↗