Accessing emergency eye care by therapeutically qualified optometrists : a simulated-patient study in Quebec, Canada

Abstract

Clinical relevance Therapeutically qualified optometrists are important providers of emergency eye care. To provide insight on how to optimise a population’s accessibility to emergency care, it is helpful to examine factors which go beyond the scope of practice and number of practitioners in a jurisdiction. Background Therapeutically qualified optometrists play an important role in managing ocular emergencies. This study assesses the accessibility of emergency eye care for a new patient in Quebec and explores associated factors such as geographical region of practices and morbidity of patient symptoms. Methods Cross-sectional study using simulated-patient design. Scripted phone calls were placed to optometry practices, posing as patients seeking emergency care. A random sample of Quebec practices was stratified by region: urban, peri-urban, and rural. Each practice received one call for a simulated conjunctivitis (low morbidity) and one for a simulated retinal break (high morbidity). Outcomes included obtaining an appointment, time-to-appointment and out-of-pocket costs. Results Eighty-nine practices participated: 30 urban, 30 peri-urban and 29 rural. Some 46% of practices granted at least one eye emergency appointment (n = 41) with significant differences between regions: 40% in urban areas, 30% in peri-urban areas and 69% in rural areas (p = 0.008). Overall, median delay to obtain an appointment was 3.7 hours (interquartile range = 1.8 – 6.3) and median fee was 55 Canadian dollars (interquartile range 50 – 65). Low-morbidity appointments were granted slightly more often (p = 0.07). Neither time-to-appointment nor fees differed significantly with morbidity or type of region. Conclusion In this simulated-patient study, less than half of optometry practices offered an emergency appointment to new patients in Quebec; more appointments were granted in rural areas and for low morbidity conditions. In a jurisdiction with many therapeutically qualified optometrists across its territory, accessibility to emergency eye care was somewhat limited, with significant geographical differences.