Authors: Yaping Jin, William Jeon, Rick H. Glazier, Michael H. Brent, Yvonne M. Buys, Graham E. Trope

Author Disclosure Block: Y. Jin: Funded grants or clinical trials; Glaucoma Research Society of Canada and Kensington Eye Institute Research Fund. W. Jeon: None. R.H. Glazier: None. M.H. Brent: Membership on advisory boards or speakers’ bureaus; Novartis Canada, Bayer Canada, Allergan Canada, and Roche Canada. Y.M. Buys: Membership on advisory boards or speakers’ bureaus; Argentum Pharmaceuticals - consultant, Bausch and Lomb - advisory board. G.E. Trope: None.

Abstract Body:

Purpose: In 2004, Ontario de-listed routine eye exams for individuals aged 20-64 unless they had a diagnosed ocular disease, diabetes or obtained a valid physician referral. We investigated if de-listing affected Ontarian’s utilization of government-insured services provided by optometrists and primary care providers (PCPs, including family physicians, paediatricians, and nurse practitioners).
Study Design: A time-series analysis.
Methods: Yearly OHIP (Ontario Health Insurance Plan) billing data from 2000 to 2014 were analyzed. Included were individuals without diabetes and/or a visit to an OHIP-insured ophthalmologist/optometrist one year prior to the study year. The utilization of OHIP-insured services provided by optometrists and PCPs for ocular diagnoses was compared post- versus pre-2004 using the interrupted time-series analysis stratified by de-listing affected (20-64 age group) and unaffected (0-19 or 65+ age group) individuals. Ocular disease diagnoses were identified using ICD-9 diagnostic codes. Diabetes was first excluded and then included as a part of ‘ocular diagnoses’. Practitioner’s specialty was recognized using specialty codes.
Results: A significant decrease was seen in OHIP-insured optometric services post- versus pre-2004 among de-listed age group when diabetes was excluded as a part of ocular diagnoses: -57% (p<0.0001) for the 20-39 group and -42% (p<0.0001) for the 40-64 group. Among de-listing unaffected 0-19 and 65+ age groups, a non-significant change in use of OHIP-insured optometric services was observed (p>0.05). The use of OHIP-insured PCP services for ocular diagnoses post- vs. pre-2004 among de-listed age groups increased significantly: +30% (p<0.0001) for the 20-39 group, and +16% (p<0.0001) for the 40-64 group. This increase was observed in both males and females and in all income earners. Among de-listing unaffected age groups changes in use of PCPs for ocular diagnoses were non-significant (p>0.05 for both 0-19 and 65+ group). The use of PCPs for non-ocular diagnoses remained stable post- vs. pre-2004 in both affected and unaffected individuals. Trends were similar when diabetes was included as a part of ‘ocular diagnoses’.
Conclusions: Post-delisting, OHIP claims by optometrists decreased significantly while PCP claims for ocular diagnoses increased among de-listed Ontarians. Due to different levels of equipment and skills among PCPs compared with optometrists, the efficiency and cost-effectiveness of increased use of PCPs for ocular diagnosis and management warrants further investigation.