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. 2014 Apr-Jun;7(2):79-85.
doi: 10.1016/j.optom.2013.05.002. Epub 2013 Jun 27.

The primary eye care examination: opening the case history and the patient's uninterrupted initial talking time

Jonathan S Pointer  1
Affiliations

The primary eye care examination: opening the case history and the patient's uninterrupted initial talking time

Jonathan S Pointer. J Optom. 2014 Apr-Jun.

Abstract
in English, Spanish

Purpose: The uninterrupted initial talking time (UITT) of optometric patients was measured in response to the clinician's opening question: "Do you have any problems with your eyes or your sight?"

Methods: UITT was measured surreptitiously by the optometrist. Also noted was whether an eye/sight problem was claimed by the patient and whether or not this was subsequently confirmed by the examination.

Results: Data were collected from 822 adults, mean age 59.1yrs (SD 17.6), range 16.0-92.0yrs. UITT data were positively skewed; median value 28.87s (IQR 19.81-43.03s) and no statistically significant difference between genders (p=0.9). 53% of patients had completed their opening statement by 30s, and 90% after 1min. 75% of these individuals (age range 26-75yrs) had a median UITT 27.82s; younger patients (16-25yrs) spoke for a significantly shorter time (18.39s: p=0.002) and elderly patients (≥76yrs) a significantly longer time (37.27s: p=0.003) than the majority value. Previously unexamined patients, habitual spectacle wearers, and individuals presenting with an eye/sight problem all recorded a significantly longer UITT (p≤0.006) than their peers. The practitioner's opening question had a sensitivity of 0.54/specificity of 0.95, and a positive predictive value (PV) of 0.78/negative PV of 0.87: with a calculated value of κ=0.53, the strength of agreement between subjective claim and objective outcome could be regarded as 'moderate'.

Conclusion: These data suggest that an optometric patient's UITT of <30s is unlikely to prove disruptive to the clinical routine.

Objetivo: Se midió el tiempo ininterrumpido de conversación inicial de los pacientes optométricos como respuesta a la pregunta introductoria del clínico: “¿Tiene Vd. problemas de visión, o en los ojos?”

Métodos: El optometrista midió el tiempo de modo subrepticio. También anotó si el paciente reportaba cualquier problema de visión/ojos, y si esto se confirmaba o no posteriormente mediante el examen.

Resultados: Se recolectó información de 822 adultos, con edad media de 59,1 años (DE 17,6), rango 16,0–92,0 años. Los datos del tiempo estaban sesgados positivamente; valor mediana 28,87s (IQR 19,81–43,03 s) y sin diferencia estadísticamente significativa entre sexos (p = 0,9). El 53% de los pacientes completó el informe introductorio a los 30 s, y el 90% al cabo de 1 minuto. El 75% de estos pacientes (rango de edad 26–75 años) empleó un tiempo medio de 27,82 s; los pacientes más jóvenes (16–25 años) hablaron durante un tiempo considerablemente menor (18,39 s: p = 0,002) y los pacientes de mayor edad (≥76 años) emplearon un tiempo considerablemente superior (37,27 s: p = 0,003) que el de la mayoría. Los pacientes no examinados previamente, los portadores habituales de gafas y los pacientes con un problema de visión/ojos registraron un tiempo significativamente superior (p ≤ 0,006) al de sus homólogos. La pregunta introductoria del médico tuvo una sensibilidad de 0,54/especificidad de 0,95, y un valor predictivo positivo (VP) de 0,78/VP negativo de 0,87: con un valor calculado de κ = 0,53, el grado de la concordancia entre la queja subjetiva y el resultado objetivo podría definirse como “moderado”.

Conclusión: Los resultados de este estudio sugieren que un tiempo ininterrumpido de conversación inicial de un paciente optométrico de <30 s es improbable que pueda perturbar la rutina clínica.

Keywords: Historia optométrica; Optometric case history; Patient's talking time; Primary eye care examination; Primer examen visual; Prueba de visión; Sight test; Tiempo de conversación del paciente.

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Figures

Figure 1
Figure 1
Distribution of the uninterrupted initial talking time (UITT: 5 s increments) of optometric patients in response to the clinician's opening question: “Do you have any problems with your eyes or your sight?” Group N = 822 (52% female).
Figure 2
Figure 2
The distribution of the UITT (s) data within six patient groupings as specified along the abscissa: in each case is shown the median value (black spot), 95% CI associated with the median estimate (box), and the IQR (whisker). The horizontal dashed red line across the plot indicates the group (N = 822) median UITT value (28.87 s).
See this image and copyright information in PMC

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