Changes in utilisation of optometry services with a non-targeted publicly-funded health care voucher system.

CLINICAL RELEVANCE: Understanding the impact of a health care voucher scheme and service access barriers could facilitate optometry service promotion to the older population. BACKGROUND: A voucher is one strategy to improve the utilisation of the different health care services available in the private sector. This study aims to explore how a health care voucher system for older people impacts utilisation of optometry services from the perspective of service users and service providers. METHODS: People aged 65 years or above were recruited to fill in a structured questionnaire studying the usage characteristics and access barriers of optometry services and the health care voucher. Views from the optometrists about the voucher scheme were collected by questionnaire. RESULTS: A total of 1156 valid questionnaires from eligible voucher users was collected. Results showed that 53.7% (621/1156) of participants had used optometry services within the past 2 years. Lack of familiarity with services provided, professional fees, and prices of spectacles were the main barriers to using optometry services. Of those participants who had used the voucher for optometry services previously, 80.4% (284/353) had an eye examination in the past 2 years. Among 389 optometrists who participated in the study, over 80% agreed that the voucher scheme improved awareness of major eye conditions and access to prescription spectacles when necessary. CONCLUSION: The health care voucher for older people improved access to optometry services. Access could be further improved by increasing price transparency of professional services and prescription spectacles. Responses from optometry service providers supported the view that the voucher scheme improved access to, and utilisation of, preventive care services.

Correctable visual impairment among people with diabetes in Hong Kong.

BACKGROUND: the prevalence of visual impairment is known to be higher in a diabetic population than in a non-diabetic population. How much of this visual impairment may be attributed to uncorrected refractive error is unclear. This study examined the prevalence of visual impairment in a Hong Kong diabetic population to determine the proportion of the visual impairment that could be corrected with prescription spectacles. METHODS: patients with type 2 diabetes mellitus (T2DM) were recruited as subjects for this study. All subjects underwent a standardised diabetic retinopathy screening that included measurement of presenting distant vision, biomicroscopic examination of the anterior eye and a retinal examination. For those subjects whose visual acuity was worse than 6/9.5, autorefraction was performed. In this study, we classified visual impairment into three categories: no visual impairment (visual acuity in the better eye better than or equal to 6/18), mild visual impairment (visual acuity in the better eye between 6/18 and 6/60) and severe visual impairment (visual acuity in the better eye less than or equal to 6/60). RESULTS: for the 2,301 subjects who participated in this study, the mean age at examination was 61.4 ± 10.5 years (range, 23 to 92 years). Regarding visual acuity, 11.3 per cent (259/2,301) of subjects had visual impairment with 10.6 per cent being mild (244/2,301) and 0.7 per cent severe (15/2,301). After correction with a prescription determined by autorefraction, the prevalence of visual impairment dropped to 4.0 per cent (91/2,301). Nearly 70 per cent (168/259) of visual impairment was correctable by prescription spectacles and 21.6 per cent (56/259) of subjects were likely to benefit from cataract surgery. CONCLUSION: for our sample of diabetic patients, nearly 70 per cent of the visual impairment could be remedied by a spectacle correction. In the care of the diabetic eye, eye-care providers should not focus solely on diabetic retinopathy. The quality of life in people with T2DM can be improved simply by eliminating uncorrected refractive errors.