Managing Outpatient Consultations in Ophthalmology: Analyzing First Consultations Outcomes

Abstract

INTRODUCTION: First consultations in ophthalmology, referred by general practitioners (GPs), significantly strain services. There is limited information on the main diagnoses and primary outcomes of these initial consultations in Portugal. This study aimed to describe the referral patterns and first consultation outcomes in the Ophthalmology service of Unidade Local de Saúde de Entre o Douro e Vouga.

METHODS: Two physicians reviewed GP referrals and first consultations over the first five months of 2023. Data on demographics, justification for referral, and consultations records were analyzed. Reasons for consultation were categorized and diagnoses were stratified according to the ICD-10 categories. Consultations were then classified by outcomes and specified accordingly.

RESULTS: Among 4917 referral-consultation pairs analyzed, 207 were excluded due to incomplete data. Chronic visual acuity loss (65.2%), diabetic retinopathy screening (11.6%), and ocular discomfort (4.9%) were the most common consultation reasons. In 11.6% of referrals, there was a prior ophthalmology evaluation. Approximately 58.8% (n=2892) resulted in discharge, 22.2% led to surgery, 11.1% were referred to a subspecialty, and 4.2% required follow-up. Of those discharged, 50.3% received a new refraction, 32.6% had no specific intervention, and others received lubrication, medical treatment, or surveillance instructions. Cataract surgery was the most frequent procedure (69.4%), and subspecialty referrals were primarily for glaucoma (21.5%) and medical retina (20.4%). There was a notable rate of incomplete data (3.2%) and duplicate consultations (0.7%) among referrals.

CONCLUSION: This study provides novel insight into the patterns of the first ophthalmology consultations in Portugal. Most referrals involve low-severity cases which can be managed conservatively. The presence of follow-up losses and duplicate consultations highlight potential areas affecting patient care. Reflecting on the role of GP in the referral process is essential, considering the burden of consultations in primary care that are mainly aimed at hospital referral. New triage strategies are needed to reduce unnecessary referrals, ensuring that only patients requiring specialized ophthalmologic care are referred. This would reduce the workload on GPs, create a more efficient system, and enhance patient access to specialized care.