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In general, referrals can be divided into two groups: the desirable but electire and the more formal or specific referral. The former presents the larger portion of the direction of optometrists to their patients to seek the service of others. These referrals are for conditions of less than an acute nature. Dental caries, periodic health examinations, obesity, general hygiene, and such subjects of health management are examples of the matters that an optometrist typically calls to the patient's attention. Rare indeed is the older patient that does not need some encouragement for better health management.
The present study is concerned with the more formal or specific type of referral, characterized by the fact that the optometrist not only undertakes to motivate the patient to seek the services of others but also initiates the communications with the essential third party to whom the patient is referred. In this type of referral the optometrist not only determines that the patient needs the services of others but that these services are required at an early date and with more certainty than the product of casual conversation or direction. These referrals are generally made to a specific practitioner or office always consulting the patient on his choice. Communication is between principals and typically generates more return discussion between them in the patient's interest.
To date, no information with an authoritative background was available on this subject of optometric referrals. In the development of their activities, several committees of the American Optometric Association felt that such a study would be desirable for several reasons : to provide information essential to proper development of the profession in a changing world; to provide information for the optimum development of interprofessional relations; and to develop information which could be used to improve the educational preparation of optometrists.
In order to provide a source of material for the current study on optometric referrals, a questionnaire was designed. It was mailed to a random sampling of 1,350 optometrists who were asked to return one copy each month for 6 consecutive months. Of the 306 who responded by returning the first month's questionnaire, 133 completed the entire series. A total of 1,360 monthly questionnaires were returned.
It is estimated that the
1 The term "patient visit” means visits to the optometrist for any reason. refracted patient uses 244 visits in connection with one refraction.
The questionnaire asked for information on the optometrist's age and length of practice, the population of his city, and the number of patient visits for that month. It asked about the number of eye physicians in the locality and the number of miles to the nearest eye physician. The age and sex of each patient referred that month and the number of years the patient had been served were included. Referrals were categorized to ophthalmologists, general practitioners of medicine, dentists, other optometrists, and other health personnel, and their record of formal acknowledgment of the patient's appearance was listed.
DISTRIBUTION OF REFERRALS
Responses to the questionnaire were well distributed geographically with a fair division between urban and rural areas as shown by table 1. There was no essential difference between the data from rural and urban areas. In four States the urban optometrists referred more patients and in four others the rural referrals were greater.
As near as can be determined, there are 18,500 optometrists in active practice in this country at the present time. If these data are projected on the basis of the total number of optometrists in active practice, it can be estimated that in the United States optometrists received 37,363,000 patient visits annually. Of these 818,360 patients are formally referred to others for some type of health service.
Of all formal referrals, 86.55 percent were made to some branch of medicines As would be expected, the larger share of referrals was made to ophthalmologists; 53.7 percent being made to them and 32.8 percent to general practitioners. Referrals to the general practitioner would be greater if full data on the desirable but elective type of referral were available. According to the study, 3.3 percent of the formal referrals were made to dentists. Of the balance, 5.1 percent were made to other optometrists and 5 percent to other miscellaneous health care personnel.
If this same distribution holds for the entire optometric profession, it would be projected to the following annual total of referrals :
439, 460 General practice_
271, 622 Dentistry
26, 990 Optometrists.
41, 736 Miscellaneous-
REFERRALS BY AGE OF OPTOMETRIST
In order to determine if there were any significant difference in referrals among older and younger optometrists, or in the number of years in practice, the data in tables 2 and 3 were compiled. These tables show a higher rate of referrals by older optometrists, though the returns from those over age 65 were too few to be fully significant. The higher percentage of referrals by the older optometrist reflects the higher average age of his patients which keeps pace with his own increased years (4). The incidence of health problems increases with the age of the patient. This pattern holds true when referrals are grouped in accordance with the number of years the optometrist has been in practice. The rate of referrals increases with the number of years, with a significant jump when the optometrist arrives at the 51-to-65 age level or has been in practice from 16 to 30 years. Referrals to his colleagues also increase from less than 1 percent on the under-50 group to 5.5 percent in the over-50 group.
REFERRALS BY SEX
There were 2,543 females and 2,076 males referred by optometrists in this study. This represents 81.6 males to 100 females, and follows closely the study made of optometric practices in California, 1956 (5). It demonstrates that the optometrist sees 80.8 males to 100 females in his regular practice.
TABLE 3.-Referrals related to number of years in practice
The best interests of the public are served when there is full and free communication between the optometrist and the professional to whom the patient is referred. The findings of the optometrist contribute to the understanding and remedial care of patients whom he refers. The knowledge communicated (3) to the optometrist adds to the latter's learning and skills. It also helps him to plan the subsequent visual care of the patient who was referred.
Of the 2,772 referrals that were directed to ophthalmologists in this study, 71.3 percent were acknowledged, either in conversion or by written communication. Of the 1,683 referrals to physicians in general practice, 45.5 percent were acknowledged. The difference is significant and may be explained by several factors. The greater area of mutual interest increases the frequency of communications between optometrists and ophthalmologists. The fact that the number of ophthalmologists is smaller than that of general practitioners means more referrals to individual eye physicians by optometrists. This, in turn, builds a greater rapport between the two. Also, by the very nature of their practice, most specialists are most adept at maintaining communications with those who refer to them (6).
This study of formal referrals, from optometrists to other health professions, points to other avenues for enquiry and study. It would be desirable to make a broader study, covering a more representative group of optometrists, and giving more attention to desirable but elective type of referral. It should include a search for information on better screening methods and procedures for determination by optometrists of any deviation from normal function. A study could be made of communications between optometrists and other professional people. This could point out the relationship of frequency of referrals to their acknowledgement. It might be directed to searching for better technics for communication between professional people. It would be desirable to know what constitutes a “patient visit” at an optometrist's office, and what relationship exists as to frequency among various kinds of visits.
1. Optometrists see a large volume of patients, many of whom exhibit signs and register symptoms of disease and malfunction that fall outside the scope of their service. If the present sampling is projected to the 18,500 optometrists in active service, it represents 37,368,000 patient visits per year.
2. Projecting the 2.19 percent referrals to patient visits in this study shows that optometrists refer 818,360 people to others for health services.
3. The greater share (53.7 percent) of optometric referrals is made to ophthalmologists according to this study. This represents 439,460 patients.
4. The next larger group of referrals (32.8 percent) is sent to general medical practitioners. This represents about 271,622 of this type of referral.
5. A smaller group of referrals (3.3 percent) was made to dentists.
6. Optometry represents a considerable health resource. Its role in the maintenance of health could be developed more effectively.
1. Howe, Henry F. Procedures in Consultation and Referrals. Gen. Practice
20:218–227 (Nov.), 1959. 2. Means, J. H. Profession or Business. New England J. Med. 261:791-797
(Oct. 15), 1959. 3. Bornmeier, W. C. Referral and Consultation. J.A.M.A. 154:440 (Jan. 30),
1954. 4. Ravine, Stanley L., and Hofstetter, H. W. Age Relationships Between Optom
etrists and Their Patients. J. Am. Opt. A. 30:124–127 (Sept.), 1958. 5. Joint Council on Visual Care, Los Angeles, Calif. Survey of Optometric
Prescriptions. (Unpublished.) 6. Fitts, Wm. T., Jr. Bull. Am. Coll. Surgeons 41:23–31 (Jan.-Feb.), 1956.
“WHERE THERE IS NO VISION The American Red Cross exists for the purpose of preventing or lightening mankind's sufferings from war, natural disaster, and disease. To achieve its objectives requires the best of a great many attributes, one of the most important of which is vision.
Good vision is necessary in the countless tasks which are performed by volunteers such as Gray Ladies, Motor Service, and Nurses' Aides, all of which hav become synonymous with Red Cross, as well as the highly skilled and technical services performed by the staff in the blood program, nursing services, disaster services, and numerous others.
Good vision is necessary, also, to help Red Cross see its ever-increasing responsibilities to a needy world; to help us see outward, not inward; to give us an enlarged vision which sees beyond barriers and difficulties. Indeed, this kind of vision is necessary to help our Nation behold its place in the family of nations that we, as a people, may help others live more abundantly.
We read in the Book of Proverbs: “Where there is no vision, the people perish.” Surely this was never more true than it is today.
GEN. ALFRED M. GRUENTHER, PRESIDENT, THE AMERICAN RED CROSS After 38 years as an officer in the U.S. Army, Gen. Alfred M. Gruenther retired from active duty in 1957 to become president of the American Red Cross, taking over command of some 3,700 chapters of volunteer workers and services.
A 4-star general, he last served as Supreme Allied Commander of Europe, a post he held since 1953. He previously served as Chief of Staff of the 3d Army under General Krueger in London. He later was named Chief of Staff of Gen. Mark Clark's 5th Army in North Africa and Italy.
General Gruenther was appointed Director of the Supreme Headquarters of the Allied Powers in Europe in 1951, and later he was named Supreme Allied Commander in Europe. He is the holder of many special citations and medals for valor and service, including a vast number of decorations by a numbers of foreign countries.
A GREAT WEALTH OF PROFESSIONAL EYE CARB
(By Arthur S. Flemming, Secretary of Health, Education, and Welfare) As with many of our greatest blessings, we are inclined to take vision for granted. We tend to forget that our sight must be protected, that much blindness is preventable, that many visual problems can be reduced if action is taken in time.
We in America are fortunate in having a wealth of professional eye care available to us. Great strides have been made in recent years in the reduction of blindness due to infectious diseases and injuries.
With further scientific advances in visual research and the fullest application of knowledge already at hand, we can look forward to still greater progress in conserving our Nation's eyesight.
AMERICAN COMMERCE, INDUSTRY, AND GOOD VISION
(By Frederick H. Mueller, Secretary of Commerce) To those among us who have been the beneficiaries of corrected vision through properly prescribed eyeglasses, there may seem little need for emphasizing the importance of keen vision in our daily pursuits. And yet, we need only to break, lose, or leave our glasses at home to find our productivityand disposition-greatly impaired. We are different persons, with newly imposed limitations of mobility and accomplishment until the eyeglasses are again at hand and keen vision restored.
The value of corrected vision is not always so obvious to those whose eyesight has gradually become impaired or who have only minor visual difficulties. Too often such persons are not aware of their need for the benefits to be derived from the professional skills of the optometrist. Nor have they any realization of the limitations which diminishing vision is progressively imposing upon their efficiency and productive capacity.
Of course, I cannot speak as a member of the optometric profession. But as a former business executive and currently the Secretary of Commerce, the subject of better vision has long been a matter of concern to me. Among the duties of the Commerce Department are the promotion and development of our free enterprise system. That system has given Americans the highest standard of living in the world. Its continued progress depends in part on how efficiently its operations are conducted. Better eyesight contributes considerably to such eíficiency.
Therefore, I reflect the appreciation of both the Commerce Department and the business community for the half century of splendid effort by the Optometric Weekly in alerting its readers to the latest techniques of vision care. Surely, the efficiency of our productive system has been raised by attention to such care.
We all recognize the importance of keen vision to the American worker who, today more than ever before, is directing complicated machinery or devices requiring precision. Nearly every industrial job demands some degree of visual proficiency, and many jobs require an exceptionally high degree of visual skill.
I am informed that research by optometric and medical experts in many highly specialized industries has proved conclusively that there is a close correlation between good visual performance and successful working performance on specific jobs. Indeed, a worker with an undetected visual defect can be not only a liability to production, but also a liability to himself and his coworkers. Statistical evidence has come to my attention which reveals that 2 out of 3 adults have inefficient vision which can handicap their work and personal job-advancement opportunities.
It is therefore understandable why thousands of individual plants, engaged in producing the products and material that have made America the greatest production line in the world, have instituted sound vision-testing programs for all employees, and some form of vision test has become a standard part of the physical examination of most workers in many more thousands of small and large plants.
Reports gathered by Department specialists indicate that the optometric profession has been very active in the search for ways and means of giving the employees of American industry the best possible and most efficient vision for their individual occupations at low cost to both employees and employers. Through their efforts, so-called occupation vision programs are today a standard and valued part of many thousands of plants engaged in almost every conceivable type of productive work. As a result of such programs, older workers are now working to later years and to full retirement with the confidence that their vision is adequate for their job performance. Millions of