Referral Process in Patients with Uveitis: A Challenge in the Health System

Abstract

Purpose

To describe the evaluation and referral process from a group of patients with uveitis presented at a specialized uveitis center in Bogotá, Colombia.

Methods

An observational descriptive cross-sectional study was performed. After applying the selection criteria, 315 clinical records were recovered. Univariate and bivariate analyses were used, reporting proportions, means and standard deviations.

Results

The mean age of the sample was 45.23 years old and 63.8% of them were females. Patients were mostly referred by retina specialists, general ophthalmologists, rheumatologists, and cornea specialists. Meantime between the first ocular symptom and uveitis specialist evaluation was 2.08 years. Patients had been previously evaluated by a mean of 1.9 ophthalmologists. In 79.9% of patients, inflammation was recognized by the remittent; however, only 4.7% of patients were correctly graded according to SUN classification. At first time consultation with the uvea specialist, 52.1% of the patients arrived with an adequate infectious panel, 58.1% with an adequate rheumatologic panel, 11.6% with aqueous humor PCR study, 65.1% with an initial etiological diagnosis, 34.9% with inadequate topical treatment, and 59.6% with inadequate systemic treatment. The mean time to reach a diagnosis by the uvea specialist was 5.27 weeks (0.10 years). A diagnostic coincidence was not reached in 58.7% of the cases.

Conclusion

The referral process to uveitis specialists is complex but highly relevant for those who suffer from this pathology. Health professionals must be aware of the standardized classification of the disease, the appropriate treatment according to the classification, and early referral to the uveologist with adequate laboratory tests.

Keywords:

• uveitis
• referral and consultation
• ophthalmologists
• disease management
• diagnosis
• Colombia

Abbreviations

ADLT, Alejandra de-la-Torre; AV, Alejandra Villalobos; JMO, Juliana Muñoz Ortiz; JRG, Juliana Reyes Guanes; MAE, María Andrea Estevez; MRS, Mario Ramos-Santodomingo; VB, Valentina Balaguera; PCR, polymerase chain reaction; SUN, standardized uveitis nomenclature.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available by the corresponding author on reasonable request.

Ethics Approval

This study adheres to the ethical principles for human research established by the Helsinki Declaration, the Belmont Report, and Colombian Resolution 008430 from 1993. The confidentiality of the information has been preserved based on the Habeas data law (Organic Law 1581 of 2012). This investigation was presented to Escuela Superior de Oftalmología del Instituto Barraquer de América´s research ethics committee. However, as it is a retrospective study and according to the policies of the institution, it did require a registration process but did not require an ethics committee approval process. It was presented, as well, to Universidad del Norte´s research ethics committee, obtaining protocol and research approval.

Consent for Publication

As it is a risk-free research, researchers are exempt, by the Colombian Resolution 008430 from 1993, from obtaining informed consent.

Acknowledgments

We thank Universidad del Rosario for their help, guidance, and financial support. We also thank Dr. Víctor Flórez García for his methodological advice.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.