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Editors Selection IGR 15-3
Medical Treatment: Compliance with AAO guidelines
Comment by Jonathan Myers on:
54532 Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma, Ong SS; Sanka K; Mettu PS et al., Ophthalmology, 2013; 120: 2462-2469
The Preferred Practice Pattern (PPP) guidelines, developed by the American Academy of Ophthalmology (AAO), are recommendations for care based on an expert panel's distillation of the literature for various conditions. The PPP guidelines are utilized by insurance companies to assess quality of care and reimbursement decisions, and are considered in questions of standard of care. Ong and coworkers have reported on resident compliance with the AAO PPP guidelines for primary open-angle glaucoma (POAG). In a review of 103 charts reflecting care by 14 residents in 2003 and 2004, the compliance with documentation of the 19 elements of the PPP guideline for POAG was good (82.6%) and exceeded 90% on most clinical measures. This compares favorably with several studies in community settings. In this study, lower levels of compliance were found for the documentation of medication related problems (58%), impact of vision on activities of daily living (49%), adjusting target pressure downward (82%), advising patients to alert physicians to medication related physical or emotional changes (5%), and referral to low vision or social services (16%). The time period predates electronic medical record use in this clinic, and thus automated documentation was not a factor.
The PPP guidelines are one effort to disseminate evidence based medicine, and would logically be part of residency training. For the period in question, the AAO Basic and Clinical Science Course (BCSC) textbooks, widely used by ophthalmology residents, referenced but did not provide the PPP guidelines for POAG and suspects. The authors note that PPP compliance could be a useful metric to evaluate residents. These guidelines are available on the AAO website, and are periodically revised to reflect new developments. Clearly more must be done if these guidelines are to become the ongoing basis for care by clinicians during and after their training.
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