title: Exploring pre-school vision screening in primary care offices in Alabama.
abstract: OBJECTIVE
  To investigate practices, barriers, and facilitators of universal pre-school vision screening (PVS) at pediatric primary care offices.
  
  
  METHODS
  Focus group sessions (FGS) were moderated on-site at nine pediatric practices. A semi-structured topic guide was used to standardize and facilitate FGS. Discussions were audiotaped, and transcriptions were used to develop themes. All authors reviewed and agreed on the resultant themes.
  
  
  RESULTS
  FGS included 13 physicians and 32 nurses/certified medical assistants (CMAs), of whom 82% personally conducted some facet of PVS. In all practices, nurses/CMAs tested visual acuity (most using a non-recommended test), and physicians completed vision screening with external observation, fix/follow, red reflex, and cover test. Facilitators included (1) accepting that PVS is a routine part of the well-child visit, and (2) using an electronic medical record with prompts to record acuity (eight of nine practices). Barriers were related to difficulty testing pre-schoolers, distractions in the office setting, time constraints, and limited reimbursement.
  
  
  CONCLUSIONS
  Responsibility for PVS is shared by physicians and nurses/CMAs; thus, interventions to improve PVS should target both. Few practices are aware of new evidence-based PVS tests; thus, active translational efforts are needed to change current primary care practices.
authors.affiliation: School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. wmarsht@uab.edu
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Marsh-Tootle
authors.forename: Marcela G
authors.initials: MG
authors.lastname: Frazier
authors.forename: Connie L
authors.initials: CL
authors.lastname: Kohler
authors.forename: Carey M
authors.initials: CM
authors.lastname: Dillard
authors.forename: Kathryn
authors.initials: K
authors.lastname: Davis
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Schoenberger
authors.forename: Terry C
authors.initials: TC
authors.lastname: Wall
mesh_terms: D000407:Alabama; D002675:Child, Preschool; D017144:Focus Groups; D006801:Humans; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015351:Vision Screening / Q000379:methods*