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Patterns of Care for Open-angle Glaucoma in Managed Care
Allen M. Fremont, MD, PhD;
Paul P. Lee, MD, JD;
Carol M. Mangione, MD, MSPH;
Kanika Kapur, PhD;
John L. Adams, PhD;
Steven L. Wickstrom, MS;
José J. Escarce, MD, PhD
Arch Ophthalmol. 2003;121:777-783.
Objectives To describe patterns of care for primary open-angle glaucoma (POAG) and assess conformance with the American Academy of Ophthalmology's Preferred Practice Pattern (PPP).
Methods We obtained administrative, survey, and eye care records data on 395 working-age patients with POAG enrolled in 6 managed care plans between 1997 and 1999. We assessed processes of care at the initial and follow-up visits, control of intraocular pressure (IOP), intervals between visits and visual field tests, and adjustments in therapy.
Results We found high rates of performance on most recommended processes during initial evaluations, although only 53% of patients received an optic nerve head photograph or drawing and only 1% had a target IOP level documented. Recommended processes were performed at 80% to 97% of follow-up visits. Using loose criteria for control, IOP was controlled in 66% of follow-up visits for patients with mild glaucoma and 52% of visits for patients with moderate to severe glaucoma. Intervals between visits and visual field tests were generally consistent with PPP recommendations. Adjustments in therapy were more likely with worse control of IOP, although adjustments occurred in only half of visits where the IOP was 30 mm Hg or higher.
Conclusions Our study suggests that, in many respects, patients with POAG are receiving care that is consistent with the PPP. However, care is falling short on several key aspects, and POAG may be undertreated relative to standards for IOP control established in recent clinical trials.
From the RAND Health Program, Santa Monica, Calif (Drs Fremont, Lee, Mangione, Kapur, Adams, and Escarce); the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, Minn (Mr Wickstrom); the Department of Ophthalmology, Duke University Eye Center, Durham, NC (Dr Lee); and the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (Drs Mangione and Escarce). The authors have no relevant financial interest in this article.
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