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Lasik Comanagement

Two doctors coordinating care can provide the best of both worlds, or the opportunity for miscommunications.


lasik comanagement
Lasik comanagement is commonly when an optometrist provides pre-op and post-op care with an ophthalmologist providing surgery.

 

Comanagement is the process of two or more independent healthcare professionals providing a patient's care. In most cases, this is when an optometrist provides the initial Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, NearVision CK, RLE, or any refractive surgery  evaluation and care after the surgery with an ophthalmologist providing only the surgical component. Often the independent optometrist has been the patient's trusted eye care provider for years or the optometrist's office is more convenient to the patient. This can be especially valuable to patients who live in rural areas.

Comanagement has been around as long as there have been allied healthcare providers, surgical specialists, and surgical subspecialists; it really is not exclusive to eye care. Nurses and doctors are the prime example of comanagement. Chiropractors and orthopedists are another. Optometrists and ophthalmologists often coordinate and share the refractive surgery patient's care.

When handled well, comanagement provides a check and balance between the patient and the surgeon, with an optometrist assisting the patient's questions and concerns. When handled poorly, comanagement can isolate the patient from the surgeon and potentially delay needed care.

It could easily be argued that the best person to handle all patient care is an ophthalmologist, but sometimes this is unrealistic. Even within an ophthalmologist's office optometrists, technicians, or allied personal perform certain procedures, such as refractions and visual fields.

Comanagement is controversial. One of the areas of controversy is the financial arrangement between comanaging professionals and doctors. Some suggest that the fees a comanaging professional collects are little more than payment for a patient referral to a doctor. Of course an optometrist needs to be paid for the services provided, but it would be improper for that payment to exceed usual and customary fees for the scope of the services provided to the patient.

We recommend that the patient separately pay the doctor for the surgical fees, the facility for the use of the laser, and the comanaging professional for the services being provided. In this manner, the patient has the opportunity to decide if the fees commensurate with the services.

It is the patient's choice if comanagement is an acceptable manner to receive care or if care provided exclusively within the ophthalmologist's facility is more appropriate. If you choose to participate in a comanaged arrangement, be sure to choose your comanaging professional as carefully as you choose your doctor.

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, NearVision CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.


Current Lasik Comanagement Medical Journal News...

Relationship between nephrologist care and progression of chronic kidney disease.

Related Articles

Relationship between nephrologist care and progression of chronic kidney disease.

N C Med J. 2007 Jan-Feb;68(1):9-16

Authors: Orlando LA, Owen WF, Matchar DB

BACKGROUND: Since chronic kidney disease (CKD) affects 11% of the United States population, and its incidence is rising, experts recommend early referral to nephrologists in the hope that it may delay the onset of end-stage disease and improve survival. However, limitations in the capacity of currently practicing nephrologists may prevent widespread early referral. OBJECTIVE: To examine the relationship between disease progression and timing of nephrology referral. STUDY DESIGN AND DATA COLLECTION: We retrospectively identified 1,553 veterans at the Durham, North Carolina VA hospital between January 1998 and December 1999 who had CKD, defined as two outpatient serum creatinines > or = 1.4 mg/dL at least three months apart. Our endpoint was a composite of progression to the next CKD stage or death. We compared the time to the composite endpoint for each CKD stage and for early CKD (stages 1-3) to advanced CKD (stages 4 and 5) using a Cox proportional hazards model for two groups: those with primary care only (PCP-only) and those with primary and nephrology care (nephrology). RESULTS: Ninety-two percent had hypertension, 52% diabetes, 49% coronary artery disease, and 89% proteinuria. Angiotensin-converting enzyme inhibitors and anti-lipid medications were used by 52% and 39%, respectively. The median number of days spent in each CKD stage and the proportion of each groups reaching the composite endpoint are--stage 1: 1,149 days, 68% of the PCP-only group and 73% of the nephrology group; stage 2: 1,206 days, 60% and 65%; stage 3: 1,158 days, 69% and 63%; and stage 4: 794 days, 86% and 72%. Adjusted survival curves for the composite endpoint were similar between the two groups for CKD stages 1 (HR 1.08 for nephrology versus PCP-only) and 2 (HR 1.20); however for CKD stages 3 (HR 0.80, p < 0.05) and 4 (HR 0.75, p < 0.05), the nephrology group gained 316, 215, and 120 more days of progression-free survival, respectively. LIMITATIONS: The major limitation is difficulty accounting for unmeasured bias in specialty referrals. We were unable to analyze stage 5-to-dialysis due to the small number of individuals with the outcome. CONCLUSION: Our data suggest that an appropriate time for nephrology comanagement of patients with CKD may be stage 3; however, prospective studies are needed to clarify the role and timing of nephrology referral.

PMID: 17500426 [PubMed - indexed for MEDLINE]

 

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Last updated Tuesday, May 06, 2008

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