Accessing emergency eye care by therapeutically qualified optometrists: a simulated-patient study in Quebec, Canada
Bibliographic record
Abstract
Clinical relevance Therapeutically qualified optometrists are important providers of emergency eye care. To provide insight on how to optimise accessibility of a population to emergency care, it is helpful to examine factors which go beyond the scope of practice and number of practitioners in a jurisdiction.Background Therapeutically qualified optometrists play an important role in managing ocular emergencies. This study assesses the accessibility of emergency eye care for a new patient in Quebec and explores associated factors such as geographical region of practices and morbidity of patient symptoms.Methods Cross-sectional study using simulated-patient design. Scripted phone calls were placed to optometry practices, posing as patients seeking emergency care. A random sample of Quebec practices was stratified by region: urban, peri-urban, and rural. Each practice received one call for a simulated conjunctivitis (low morbidity) and one for a simulated retinal break (high morbidity). Outcomes included obtaining an appointment, time-to-appointment and out-of-pocket costs.Results Eighty-nine practices participated: 30 urban, 30 peri-urban and 29 rural. Some 46% of practices granted at least one eye emergency appointment (n = 41) with significant differences between regions: 40% in urban areas, 30% in peri-urban areas and 69% in rural areas (p = 0.008). Overall, median delay to obtain an appointment was 3.7 hours (interquartile range = 1.8–6.3) and median fee was 55 Canadian dollars (interquartile range 50–65). Low-morbidity appointments were granted slightly more often (p = 0.07). Neither time-to-appointment nor fees differed significantly with morbidity or type of region.Conclusion In this simulated-patient study, less than half of optometry practices offered an emergency appointment to new patients in Quebec; more appointments were granted in rural areas and for low morbidity conditions. In a jurisdiction with many therapeutically qualified optometrists across its territory, accessibility to emergency eye care was somewhat limited, with significant geographical differences.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".