Understanding decision making factors influencing referrals to vision rehabilitation services at a tertiary medical center

Functional vision loss at any stage affects quality of life (QOL) even
before clinically quantified to be moderate or severe. Eye care providers
(ECP) are the gatekeepers to vision rehabilitation services (VRS) and
often underestimate how small variations in functional vision loss can
have a significant impact in a patient’s life. Greater patient-provider
communication about vision loss is an opportunity to build trust and
increase access to VRS to improve QOL. Tertiary eye care centers serve the
greatest number of visually impaired (VI) patients. The purpose of this
study was to find what factors influenced ECPs with VRS referral
decision-making at a tertiary medical center. We also further studied
whether decision making was influenced by the ECP’s specialty, volume of
practice, years of practice, number of practicing locations, gender, and
continuing education (CE) status. Our survey found that about 77% of
respondents, early (<10 years) in their career, and 75% posterior
segment (PS) specialists agreed that people with any functional vision
complaint should be referred to VRS regardless of visual acuity status.
Fifty-two percent of all respondents indicated the reason for low
referrals to VRS was to a lack of inquiry by patients about vision
services. Inquiry about driving status by patients was an important factor
for referral to VRS for 35% of respondents, and especially for PS
specialists. Forty-five percent of respondents reported lack of VRS
providers and long wait times as a barrier to referrals; however, 68%
respondents reported never referring to community services. PS specialists
attended more CE courses related to low vision/ vision rehabilitation than
anterior segment (AS) specialists. By understanding influencers on
ECPs' decision-making, we will be able to make more targeted
recommendations on workflow changes, continuing education, and quality
improvement processes to increase access to vision rehabilitation
services.