title: The gatekeeper in vision care. An analysis of the co-ordination of professional services in The Netherlands.
abstract: Data from a national survey were used to explore the position of ophthalmologists, general practitioners, orthoptists, optometrists and opticians in the domain of vision care services. Options for organising the gatekeeper function were analysed. This was done on the basis of six cases that the five key occupations considered as their overlapping areas. Nearly all respondents reported to be consulted by patients with the given complaints, indicating rather unclear boundaries between the professions. Further, the opinions indicated preference for a medical gatekeeper (ophthalmologist, GP) rather than a non-medical one (optometrist). Lack of agreement on suggested gatekeeper options suggest other options to consider, like regional networks of GPs, ophthalmologists, orthoptists and optometrists who share the responsibility for a specified client population. At present, such innovative arrangements are being introduced. GPs and optometrists could share the responsibility for gate-keeping and for referring patients to more specialised services.
authors.affiliation: Section of Medical Sociology, Department of Health Care Studies, University of Maastricht, P.O. Box 616, The Netherlands. f.stevens@zw.unimaas.nl
authors.forename: Fred C J
authors.initials: FC
authors.lastname: Stevens
authors.forename: Frans
authors.initials: F
authors.lastname: van der Horst
authors.forename: Fred
authors.initials: F
authors.lastname: Hendrikse
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice / Q000706:statistics & numerical data; D020793:Gatekeeping / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D009313:National Health Programs; D009426:Netherlands; D009885:Ophthalmology / Q000706:statistics & numerical data; D009907:Optometry / Q000706:statistics & numerical data; D009988:Orthoptics / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D017009:Professional Autonomy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D015351:Vision Screening / Q000458:organization & administration* / Q000706:statistics & numerical data