Patterns of care for open-angle glaucoma in managed care.
OBJECTIVE
To describe patterns of care for primary open-angle glaucoma (POAG) and assess conformance with the American Academy of Ophthalmology's Preferred Practice Pattern (PPP).


METHODS
We obtained administrative, survey, and eye care records data on 395 working-age patients with POAG enrolled in 6 managed care plans between 1997 and 1999. We assessed processes of care at the initial and follow-up visits, control of intraocular pressure (IOP), intervals between visits and visual field tests, and adjustments in therapy.


RESULTS
We found high rates of performance on most recommended processes during initial evaluations, although only 53% of patients received an optic nerve head photograph or drawing and only 1% had a target IOP level documented. Recommended processes were performed at 80% to 97% of follow-up visits. Using loose criteria for control, IOP was controlled in 66% of follow-up visits for patients with mild glaucoma and 52% of visits for patients with moderate to severe glaucoma. Intervals between visits and visual field tests were generally consistent with PPP recommendations. Adjustments in therapy were more likely with worse control of IOP, although adjustments occurred in only half of visits where the IOP was 30 mm Hg or higher.


CONCLUSIONS
Our study suggests that, in many respects, patients with POAG are receiving care that is consistent with the PPP. However, care is falling short on several key aspects, and POAG may be undertreated relative to standards for IOP control established in recent clinical trials.
Fremont
Allen M
AM
RAND Health Program, Santa Monica, Calif, USA.
Lee
Paul P
PP
Mangione
Carol M
CM
Kapur
Kanika
K
Adams
John L
JL
Wickstrom
Steven L
SL
Escarce
José J
JJ
D000959:Antihypertensive Agents / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D018463:Filtering Surgery; D020327:Glaucoma Drainage Implants; D005902:Glaucoma, Open-Angle / Q000628:therapy*; D019983:Guideline Adherence; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D009885:Ophthalmology / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D014794:Visual Fields
D000959:Antihypertensive Agents