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dc.contributor.advisorElliott, David B.
dc.contributor.advisorHarley, Clare
dc.contributor.advisorGreen, Clare
dc.contributor.authorDavey, Christopher J.*
dc.date.accessioned2013-05-02T15:39:59Z
dc.date.available2013-05-02T15:39:59Z
dc.date.issued2013-05-02
dc.identifier.urihttp://hdl.handle.net/10454/5526
dc.description.abstractPrevious 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.en_US
dc.language.isoenen_US
dc.rights<a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>.eng
dc.subjectOptometryen_US
dc.subjectOphthalmologyen_US
dc.subjectReferralen_US
dc.subjectAnxietyen_US
dc.subjectReferral qualityen_US
dc.subjectRasch analysisen_US
dc.subjectFalse positiveen_US
dc.subjectState-Trait Anxiety Inventory (STAI)en_US
dc.subjectAnxiety and Depression Scale (HADS)en_US
dc.titleReferrals from Primary Eye Care: An Investigation into their quality, levels of false positives and psychological effect on patients.en_US
dc.type.qualificationleveldoctoralen_US
dc.publisher.institutionUniversity of Bradfordeng
dc.publisher.departmentBradford School of Optometry and Vision Scienceen_US
dc.typeThesiseng
dc.type.qualificationnamePhDen_US
dc.date.awarded2011
refterms.dateFOA2018-07-19T11:50:34Z


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