What factors influence the optometric referral reply rate? A mixed methods study

Purpose: Community optometrists are primary eye care providers. Through the routine sight test, optometrists can engage in opportunistic case finding, identifying patients who present with disease or ocular abnormalities that require referral for secondary medical care. Optometrists refer patients but in many cases no referral outcome letter/reply is received. In the absence of a reply, patients often need to be re-referred unnecessarily, potentially increasing the number of other patients who lose sight whilst waiting on extensive hospital waiting lists. Sight loss could be irreversible. To increase/optimise the number of referral reply letters from secondary care it is necessary to understand what factors influence the optometric referral reply rate. Methods: Ethics approval was obtained for a multiphase sequential mixed methods primary research study (qual - QUAN - qual). Documentary analysis of 349 patient referral records from three optometric practice modalities (domiciliary practice, an independently owned group and an optical corporate chain) were quantitatively investigated using IBM SPSS Statistics 25 software. One-on-one, semi-structured interviews were used to obtain the views of thirteen stakeholders These were qualitatively analysed using NVivo 12 software. Results: A referral reply rate of 11.2% was calculated. Factors influencing the optometric referral reply rate included; technology, the GP, optometrists’ utility to and utility of the NHS, patient mobilisation and individual behavioural differences. Conclusion: Community optometrists can and should improve the referral reply rate by responding to the factors identified.