title: Clinic-based glaucoma care in the era of surgical subspecialization.
abstract: OBJECTIVE
  To evaluate the impact of surgeon practice profile on clinic-based glaucoma care.
  
  
  METHODS
  Population-based study of glaucoma care patterns in Ontario, Canada from 2000-2010.
  
  
  METHODS
  Using comprehensive physician services data from the Ontario Health Insurance Plan database, ophthalmologists were divided into 5 surgical practice subgroups. The role of each subgroup in the provision of glaucoma care was evaluated. Consultations and office visits were used to assess nonsurgical care, while laser trabeculoplasty procedures were used to assess clinic-based procedural care.
  
  
  RESULTS
  Between 2000 and 2010, the population rate of glaucoma consultations and follow-up visits provided by ophthalmologists who do not perform incisional glaucoma surgery increased at average annual rates of 1.6% (P < .0002) and 3.3% (P < .0001), respectively. In contrast, no significant growth in the rate of glaucoma consultations or follow-up visits provided by glaucoma surgeons was observed (0.8%/year [P = .2] for consultations; 0.2%/year [P = .6] for follow-up visits). Between 2000 and 2010, the rate of laser trabeculoplasty procedures provided by ophthalmologists who do not perform incisional glaucoma surgery increased 19.3% annually (P < .0001), while growth among glaucoma surgeons was more modest (annual growth of 9.2% [P = .0002]).
  
  
  CONCLUSIONS
  While subspecialization is a growing reality in most areas of medicine, we found that the provision of clinic-based glaucoma care remains dependent on ophthalmologists who do not perform incisional glaucoma surgery. With increasing focus on integrated care, these findings will have important implications for residency education programs and their accrediting bodies and will inform decisions of health care policymakers, hospitals, and academic departments.
authors: Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada; Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences - Queen's University Site, Queen's University, Kingston, Ontario, Canada. Electronic address: rob.campbell@queensu.ca.
authors: Robert J
authors: RJ
authors: Campbell
authors: Institute for Clinical Evaluative Sciences - Sunnybrook Site, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Chaim M
authors: CM
authors: Bell
authors: Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences - Queen's University Site, Queen's University, Kingston, Ontario, Canada; Division of Geriatric Medicine, St. Mary's of the Lake Hospital, Kingston, Ontario, Canada.
authors: Sudeep S
authors: SS
authors: Gill
authors: Institute for Clinical Evaluative Sciences - Queen's University Site, Queen's University, Kingston, Ontario, Canada; Queen's University, Kingston, Ontario, Canada.
authors: Marlo
authors: M
authors: Whitehead
authors: Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada; Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Ontario, Canada.
authors: Erica de L P
authors: Ede L
authors: Campbell
authors: Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada; Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Ontario, Canada.
authors: Kunyong
authors: K
authors: Xu
authors: Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ontario, Canada.
authors: Sherif R
authors: SR
authors: El-Defrawy
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053685:Laser Therapy / Q000706:statistics & numerical data; D009819:Office Visits; D009864:Ontario; D009885:Ophthalmology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013043:Specialties, Surgical; D014130:Trabeculectomy / Q000706:statistics & numerical data*
chemical_list: D000959:Antihypertensive Agents