Primary care provider views of the current referral-to-eye-care process: focus group results.

Purpose. To understand the barriers facing primary care providers (PCPs), including nurse practitioners (NPs) and physician assistants (PAs), in the current referral-to-eye-care process and to solicit suggestions from PCPs on how to improve the current referral system. Methods. Four focus groups were conducted with a total of 17 PCPs: two groups with physicians (MDs): one in a rural setting and one in an academic medical center setting and one group of NPs and one of PAs, both in an academic setting. All discussions were audiotaped and transcribed, and both authors performed content analysis of the transcripts with the assistance of qualitative software. Results. The most frequently cited referral barriers included: (1) poor communication from eye care providers (ECPs), (2) patients' lack of finances/insurance coverage, and (3) difficulty in scheduling an eye care appointment. Suggestions made in all groups on ways to improve the current referral system included (1) implementing electronic medical records (EMRs), (2) receiving better communication/feedback from ECPs, (3) having ophthalmologists hold clinic days in primary care facilities, and (4) performing retinal scans in primary care clinics. We found few differences between the opinions of MDs and those of NPs and PAs. Conclusions. PCPs desire change(s) in the current referral-to-eye-care system. Better communication between PCPs and ECPs, further implementation of EMRs, and increasing eye screening in primary care clinics were common themes. Implementing specific suggestions, such as modernizing medical record systems, may help to increase eye care utilization among patients at high risk for advancing eye disease and vision loss.