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    Referrals from Primary Eye Care: An Investigation into their quality, levels of false positives and psychological effect on patients.

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    CJDavey Thesis18.pdf (2.326Mb)
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    Publication date
    2013-05-02
    Author
    Davey, Christopher J.
    Supervisor
    Elliott, David B.
    Harley, Clare
    Green, Clare
    Keyword
    Optometry
    Ophthalmology
    Referral
    Anxiety
    Referral quality
    Rasch analysis
    False positive
    State-Trait Anxiety Inventory (STAI)
    Anxiety and Depression Scale (HADS)
    Rights
    Creative Commons License
    The University of Bradford theses are licenced under a Creative Commons Licence.
    Institution
    University of Bradford
    Department
    Bradford School of Optometry and Vision Science
    Awarded
    2011
    
    Metadata
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    Abstract
    Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.
    URI
    http://hdl.handle.net/10454/5526
    Type
    Thesis
    Qualification name
    PhD
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