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Diagnostic Accord between Primary Care Physicians and Ophthalmologists

Ebtisam Al-Alawi, FRCS, MRCOphth, DO; Ahmed Abdulla Ahmed, MD, MPH; Bahaa El-Din Fateha, MD, Dr.PH; Hussain Shaker, FRCS.

PURPOSE
The Primary Health Care Service (PHC) is the cornerstone of the health care system in Bahrain, consisting of 21 health care faciliti8es, which cover all the population centers of the country. The PHC physician is expected to deal with a wide variety of medical and surgical ailments, including ophthalmic conditions which must be diagnosed and treated or referred, when indicated, to ophthalmic consultants at Salmaniya Medical Complex (SMC).

PATIENTS AND METHODS
A prospective study was performed of all patients referred to the ophthalmology clinic at SMC by the PHC between 1 November 1994 and 1 April 1995. The clinical diagnoses of the PHC physicians and the ophthalmologists were compared. The ophthalmologist consultant's diagnosis was considered definitive and PHC physician's diagnosis was classified as concordant or discordant. Diagnostic discordance was attributed to either lack of appropriate instrumentation or to inadequate ophthalmic knowledge and/or diagnostic skills.

RESULTS
During the study period, 531 referrals were made to the ophthalmology clinic. There was diagnostic concordance in 409 (77%) referrals and diagnostic discordance in 122 (23%) referrals. Diagnostic categories with high concordance rates were trauma, cataract, and nasolacrimal disorders, while discordance rates were high for glaucoma and strabismus. Diagnostic discordance was attributed to lack of sufficient instruments in only 18 (5%) cases.

CONCLUSION
Primary care physicians can properly diagnose most ophthalmic cases seen in primary health care centers. The ability to screen and diagnose important ophthalmic disorders requires proper training and basic instrumentation (visual acuity charts, Schiotz tonometers, and direct ophthalmoscopes), and can be done adequately without sophisticated equipment.

Middle East Journal of ophthalmology, 2001;9:2 21:23