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As a possible mechanism to address the inequality in eye care, free eye examinations are delivered by high-street optometrists in Scotland on the grounds that they are more readily accessible to the public.1
We aim to compare the location of optometry premises according to the level of deprivation, geographic access and total population in Tayside.
Using the postcode of optometry premises and general practitioner (GP) practices within Tayside (Angus, Dundee City, Perth & Kinross), we obtained the overall Scottish Index of Multiple Deprivation 2012 (SIMD) score, and geographic access to services score for each of the premises. From the census data 2010, we obtained the population within each datazone.
The overall SIMD score is an area-based index of multiple deprivation encompassing seven domains: income, health, crime, employment, housing, geographic access and education. The larger the SIMD score, the more deprived an area.
The geographic access domain is a population-weighted indicator of the average time taken to reach key services by either public transport or driving. A larger geographic access score denotes an area with poorer access to key services.
We used the ‘maptools’ package in R Statistics for spatial analysis.2
The t test was used to compare the mean SIMD and geographic access scores for the optometry premises and GP practices.
The population of Tayside is 402 640. There are 59 optometry premises and 63 GP practices (table 1). The mean overall SIMD scores for optometry premises and GP practices are 24.26 and 22.98, respectively (z-score=0.53, p=0.59). In terms of geographic access, the mean score for the optometry premises, 3.77, is lower than the score for GP practices, 9.73. There is a statistically significant difference in the mean geographic access scores for the optometry premises and GP practices, GP practices tending to be located in areas with poorer access to key services (z-score=2.86, p=0.004).
The geographical map of Dundee City illustrates two clusters of optometry premises within the high-street areas (figure 1). There is a clear mismatch between location of optometry premises in Dundee City (n=39) and areas of poor accessibility. GP practices (n=40) are more evenly distributed within the most inaccessible areas.
In this study, we have shown that optometry premises in Tayside are unevenly distributed. There is a gap in distribution of optometry premises within areas of high deprivation and poor geographic access in Dundee City. Such a mismatch in location of optometry premises in areas of deprivation in Northern England has previously been recognised.3 Although most of the optometry premises are located in accessible areas via public transport, they are not available locally. This poses an added cost barrier to less affluent patients seeking eye care; it is recognised that they have not taken up free National Health Service (NHS) sight tests as much as the more affluent ones.4 Other barriers to access include public perception of the role of high-street optometrists and fear of being pressurised to purchase spectacles.5 High-street optometry premises are essentially business entities. Since the majority of their revenue is not derived from providing NHS sight examinations, they are more likely to be located in the most profitable areas. Therefore, alternative incentive packages and targeted outreach programmes are needed to overcome this inequality in access.5 Our study supports the stance of the Royal College of Ophthalmologists that informed, evidence-based analysis is needed before any radical shift towards provision of primary eye care services by high-street optometrists is undertaken.6
Contributors All authors contributed equally in the study design, data acquisition, data analysis, critical review of manuscript and final approval for publication.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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