As optometrists continue to evolve as essential primary health care providers in their expanded role in health care reform, a number of us are striving to meet the challenge. There is increasing evidence that a primary health care wellness encounter could be a separate and distinct service from the comprehensive eye examination.
This service could follow the path of the Optomap wellness retinal scan (Optos) that is offered by many optometrists as an optional wellness service for a separate charge.
A primary care wellness exam would ideally include the following data points:
- blood pressure
- body mass index
- glucose measurements (finger stick, lab test of HA1c or measure of autofluorescence)
In addition, information from the comprehensive eye examination would feed into the complete wellness picture. This would include the comprehensive family history, the patient’s personal health history, social life habits and observed clinical findings of systemic disease, which would include findings such as diabetic retinopathy and hypertensive retinopathy.
From this collection of data, a risk profile can be created. The risk specifically would be related to developing long-term disability from chronic medical problems. The long-term risk of these problems also can come back around to affect the eye and vision, resulting in reduced function in cases of diabetic eye disease, vascular eye disease and age-related macular degeneration.
For young patients, one of the most significant risk factors is the family history. According to the American Diabetes Association, the risk of a patient with one parent with type 1 diabetes is between one in 17 to one in 100. If both parents have type 1 diabetes, the risk is one in four. Surprisingly, the risk of developing type 2 is even greater. If one parent has type 2 diabetes, the risk is between one in seven to one in 13. If both parents have type 2 diabetes, the risk is one in two! In spite of this strong relationship, it is the development of type 2 diabetes that can be most affected by lifestyle changes.
Hypertension is also strongly correlated with family history. According to a recent article in the Journal of Hypertension, this is even more significant in men. This chronic disease is also best managed with early diagnosis and lifestyle modification.
The collection of these risk factors can easily be tabulated and analyzed to create a “wellness report card.” This can be reviewed at the end of the encounter, and a printout can be provided for each patient. This report card can be a platform for patient wellness education and counseling for patients with mild to moderate risk and can also be the foundation of a referral to a primary care physician in cases of high to severe risk.
Risk calculators and report cards are a common way to introduce a discussion about wellness and lifestyle changes. There are many good examples of this online to help create your own version.
Sources such as the American Diabetes Association “Type 2 risk test” and The High Blood Pressure Health Risk Calculator from the American Heart Association are a great place to get you started.
Primary care report cards are yet another tool in the optometrist’s journey from primary eye care to primary health care. Take a look at this simple option to evolve your practice for health care reform.
Chiu CL, et al. J Hypertension. September 2012. doi: 10.1097/01.hjh.0000420137.23485.be.