title: Same eyes, different doctors: differences in primary care physician referrals for diabetic retinopathy screening.
abstract: OBJECTIVE
  To analyze eye care specialist referral patterns for the diabetic patients of primary care physicians.
  
  
  METHODS
  In 1993, we conducted a census of primary care physicians to evaluate practice patterns relating to diabetes care in the state of Indiana. Using a logistic regression model and data from this census, we compared 1) physicians' odds of referring type II diabetic patients to an optometrist, as opposed to an ophthalmologist, with those of type I diabetic patients and 2) the referral odds ratios of type II to type I diabetic patients between metropolitan and nonmetropolitan counties.
  
  
  RESULTS
  Overall, 10% of the physicians in our study most often refer some patients to an optometrist. Physicians are more likely to refer their type II diabetic patients to an optometrist, as opposed to an ophthalmologist, than they are to refer type I diabetic patients, both before and after adjustment for covariates. Physicians who practice in metropolitan counties are 1.55 times more likely to refer their type II diabetic patients than their type I diabetic patients to an optometrist. In nonmetropolitan counties, physicians are 2.5 times more likely to refer their type II diabetic patients to an optometrist. The difference between metropolitan and nonmetropolitan physicians is significant (P = 0.027).
  
  
  CONCLUSIONS
  Some physicians mostly refer their diabetic patients to optometrists, instead of ophthalmologists, for eye examinations intended to discover early signs of diabetic eye disease. Type II diabetic patients are more likely to be referred to an optometrist, instead of an ophthalmologist, than are type I diabetic patients. In nonmetropolitan areas, the difference in referral patterns becomes even more marked.
authors.affiliation: Diabetes Research and Training Center, Indiana University School of Medicine, Indianapolis, USA. elazarid@iupui.edu
authors.forename: E N
authors.initials: EN
authors.lastname: Lazaridis
authors.forename: C
authors.initials: C
authors.lastname: Qiu
authors.forename: S K
authors.initials: SK
authors.lastname: Kraft
authors.forename: D G
authors.initials: DG
authors.lastname: Marrero
mesh_terms: D019352:Censuses; D048909:Diabetes Complications; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000628:therapy; D005194:Family Practice / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D007196:Indiana; D016015:Logistic Models; D008137:Longitudinal Studies; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires