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Accuracy of diagnosis of eye diseases referred by primary health-care physicians in Jeddah City, Saudi Arabia

Mazen AlGhamdi.

Abstract
Background: Proper clinical approach of primary health-care (PHC) physicians is very important for proper diagnosis and management of ophthalmic diseases. Inaccurate diagnosis leads to unnecessary referrals.

Objective: The objective of this study was to assess the diagnostic accuracy of eye diseases among patients referred to Jeddah Eye Hospital (JEH) and to explore differences in diagnostic accuracy in relation to patients’ gender, age, and ophthalmic conditions.

Materials and Methods: A cross-sectional study was conducted on 316 patients referred to JEH. The accuracy of diagnosis was evaluated by comparing PHC physicians’ and ophthalmologists’ diagnoses.

Results: PHC physicians correctly diagnosed 29% of referred cases. History taking and physical examination were done in 85.1% and 21.5% of cases, respectively. The diagnosis was significantly more accurate when they were fulfilled (P < 0.001 and P = 0.002, respectively). Diagnosis of cases referred by family physicians (42.9%) was more accurate than those referred by general practitioners (27.4%). Chalazion and squint were significantly more accurately diagnosed, while the accuracy was significantly lower if the diagnosis was allergic conjunctivitis.

Conclusions: More than two-thirds of PHC physicians’ diagnoses for referred eye patients were not accurate. Diagnostic accuracy was higher with squint or chalazion when the PHC physicians performed history taking and physical eye examination. Continuing medical education in ophthalmology is highly needed, and the rotation of ophthalmology for postgraduate residents in family medicine must be enforced. Enhancing the availability of basic ophthalmic examination tools such as ophthalmoscopes and visual acuity charts in PHC clinics is recommended. The development of definite referral protocols for PHC physicians is highly recommended.

Key words: Eye Disease; Primary Health Care; Family Physician



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