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.
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