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Bianchi E, Reddingius PF, Rathore M, Lindfield D, Crabb DP, Jones PR. Pushing the envelope: the feasibility of using a mailed contrast sensitivity test to prioritise cataract waiting lists. Eye (Lond) 2024:10.1038/s41433-024-03081-6. [PMID: 38802486 DOI: 10.1038/s41433-024-03081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Cataract waiting lists are growing globally. Pragmatic, cost-effective methods are required to prioritise the most urgent cases. Here we investigate the feasibility of using a third-party pen-and-paper contrast sensitivity, CS, test (SpotChecksTM), delivered by mail, and performed by patients at home unsupervised, to flag eyes requiring surgery. METHODS Pen-and-paper CS tests were mailed to 233 people waiting for a cataract assessment, along with a prepaid return envelope (cross-sectional study). Response rates were tabulated (stratified by age, sex and socioeconomic status), and test scores analysed to see how well the home tests predicted which eyes were listed subsequently for surgery. A subset of patients (N = 39) also underwent in-person follow-up testing, to confirm the accuracy of the home data. RESULTS Forty-six percent of patients responded (216 eyes). No gross differences were observed between respondents and non-respondents, either in terms of age, sex, socioeconomic status, or geographic location (all P > 0.05). The home-test CS scores predicted which eyes were subsequently listed for surgery, with an AUROC {±CI95%} of 0.69 {0.61-0.76}. Predictive performance was further-improved when machine learning was used to combine CS scores with letter acuity, extracted from patients' medical records (AUROC {±CI95%} = 0.77 {0.70-0.83}). Among 39 patients who underwent follow-up testing, home CS scores were correlated with various measures made in clinic: biometry signal-to-noise (P = 0.032), LogMAR acuity, Pelli-Robson CS and SpotChecks CS (all P < 0.001). CONCLUSIONS Mailing patients pen-and-paper CS tests may be a feasible, 'low-tech' way of prioritising patients on cataract waiting lists.
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Affiliation(s)
- Eleonora Bianchi
- Glaucoma Services, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Peter F Reddingius
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, England
| | - Mehal Rathore
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, England
| | - Dan Lindfield
- Glaucoma Services, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - David P Crabb
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, England
| | - Pete R Jones
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, England.
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Carmichael J, Abdi S, Balaskas K, Costanza E, Blandford A. Assessment of optometrists' referral accuracy and contributing factors: A review. Ophthalmic Physiol Opt 2023; 43:1255-1277. [PMID: 37395045 PMCID: PMC10946769 DOI: 10.1111/opo.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE In the UK, ophthalmology has the highest number of outpatient appointments within the National Health Service. False-positive referrals from primary care are one of the main factors contributing to the oversubscription of hospital eye services (HESs). We reviewed the accuracy of referrals originating from primary care optometrists and contributing factors, such as condition type and years since registration. RECENT FINDINGS Of the 31 studies included in the review, 22 were retrospective analyses of referrals and appointments at the HES. Eight were prospective studies, and one used online clinical vignettes. Seven assessed the accuracy of referrals for all ocular conditions. The remaining studies focused on glaucoma (n = 11), cataracts (n = 7), emergency conditions (n = 4), neovascular age-related macular degeneration (n = 1) and paediatric binocular vision (n = 1). The diagnostic agreement for suspected emergency ocular conditions was the lowest, with only 21.1% of referrals considered to require urgent attention in one study. For glaucoma, the first-visit discharge rate was high (16.7%-48%). Optometrist referral accuracy was overall 18.6% higher than General Medical Practitioners'; however, the two mainly referred different ocular conditions. Female optometrists made more false-positive referrals than males (p = 0.008). The proportion of false positives decreased by 6.2% per year since registration (p < 0.001). SUMMARY There was significant variation in referral accuracy across different ocular conditions, partly due to differences when defining accurate referrals. Optometrists working in primary care are generally more limited in their resources than the HES. Thus, choosing the cautious option of referral when they are unsure could be in the patients' best interests. The possible effect of increased use of advanced imaging on referrals requires evaluation. Although interventions such as refinement schemes have been put in place, these vary across regions, and their approaches such as virtual referral triaging may reduce unnecessary HES face-to-face appointments and promote communication between primary and secondary care.
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Affiliation(s)
- Josie Carmichael
- University College London Interaction Centre (UCLIC), UCLLondonUK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCLInstitute of OphthalmologyLondonUK
| | - Sarah Abdi
- University College London Interaction Centre (UCLIC), UCLLondonUK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCLInstitute of OphthalmologyLondonUK
| | - Enrico Costanza
- University College London Interaction Centre (UCLIC), UCLLondonUK
| | - Ann Blandford
- University College London Interaction Centre (UCLIC), UCLLondonUK
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March de Ribot F, de Ribot AM, Walker X, Jamieson H, Cheung G. Dementia and cataract surgery in Australia and New Zealand. Australas J Ageing 2023; 42:450-454. [PMID: 37127536 DOI: 10.1111/ajag.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Cataract surgery improves quality of life and reduces cognitive deterioration. OBJECTIVES This paper discusses the health implications of low vision, commonly related to cataracts, in older adults. A recent publication reported that cataract surgery reduces the risk of dementia by 30% over 10 years. METHODS We searched Medline from inception to January 2023. We also conducted backward and forward citation searches of included studies and set up alerts to identify studies published after the search date. We performed discussion groups with multidisciplinary experts. RESULTS This article provides a broad description of the importance of vision for cognitive function. We discuss access to public-funded cataract surgery in Australia and New Zealand and how this impacts population benefits. CONCLUSIONS We have evidence that cataract surgery can decrease the risk of dementia. This is an important topic that deserves recognition as part of an overall ageing response by policymakers and health professionals.
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Affiliation(s)
| | - Anna March de Ribot
- Ophthalmology, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Xaviour Walker
- Older Person's Health, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Hamish Jamieson
- Older Person's Health, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Gary Cheung
- Psychological Medicine, Auckland University, Auckland, New Zealand
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Chia MA, Turner AW. Benefits of Integrating Telemedicine and Artificial Intelligence Into Outreach Eye Care: Stepwise Approach and Future Directions. Front Med (Lausanne) 2022; 9:835804. [PMID: 35391876 PMCID: PMC8982071 DOI: 10.3389/fmed.2022.835804] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Telemedicine has traditionally been applied within remote settings to overcome geographical barriers to healthcare access, providing an alternate means of connecting patients to specialist services. The coronavirus 2019 pandemic has rapidly expanded the use of telemedicine into metropolitan areas and enhanced global telemedicine capabilities. Through our experience of delivering real-time telemedicine over the past decade within a large outreach eye service, we have identified key themes for successful implementation which may be relevant to services facing common challenges. We present our journey toward establishing a comprehensive teleophthalmology model built on the principles of collaborative care, with a focus on delivering practical lessons for service design. Artificial intelligence is an emerging technology that has shown potential to further address resource limitations. We explore the applications of artificial intelligence and the need for targeted research within underserved settings in order to meet growing healthcare demands. Based on our rural telemedicine experience, we make the case that similar models may be adapted to urban settings with the aim of reducing surgical waitlists and improving efficiency.
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Affiliation(s)
- Mark A. Chia
- Lions Outback Vision, Lions Eye Institute, Nedlands, WA, Australia
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Angus W. Turner
- Lions Outback Vision, Lions Eye Institute, Nedlands, WA, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, WA, Australia
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Hambisa MT, Dolja-Gore X, Byles J. Application of Andersen-Newman model to assess cataract surgery uptake among older Australian women: findings from the Australian Longitudinal Study on Women's Health (ALSWH). Aging Clin Exp Res 2022; 34:1673-1685. [PMID: 35184260 PMCID: PMC9246771 DOI: 10.1007/s40520-022-02091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although Cataract Surgery Rate is increasing, the availability of surgery is outstripped by the increasing number of cataract cases as populations age. AIM The study aimed to identify factors associated with cataract surgery uptake in terms of predisposing, enabling, and need factors in very old Australian women. METHOD This study used ALSWH data included 6229 women aged 79-84 to 85-90 years. Women were asked whether they had undergone eye surgery (including cataracts) three years prior to each survey. Generalised estimating equation modelling was used to determine factors associated with these surgeries. RESULT At baseline (2005), more than half of the participants either had undergone surgery (43.5%) or had unoperated cataracts (7.6%). Increasing age (AOR = 1.11, 95% CI = 1.07, 1.15) and being current or ex-smokers (AOR = 1.15, 95% CI = 1.03, 1.29) were associated with higher odds of cataract surgery (predisposing factors). Women who had private health insurance had 27% higher odds of having surgery (AOR = 1.27, 95% CI = 1.16, 1.39) (enabling factor). Need factors of more General Practitioner visits (AOR = 1.16, 95% CI = 1.09, 1.25) and skin cancer (AOR = 1.09, 95% CI = 1.01, 1.17) also increased the odds of cataract surgery. Women who had no difficulty seeing newspaper print were more likely to have had cataract surgery (AOR = 1.35, 95% CI = 1.23, 1.48). CONCLUSION Need factors are the major drivers of cataract surgery; however, predisposing and enabling factors also play a role, including access to private health insurance. This finding indicates some inequity regarding access to cataract surgery in the Australian setting.
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Affiliation(s)
- Mitiku Teshome Hambisa
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia.
- School of Public Health, Haramaya University College of Health and Medical Sciences, P. O. Box 235, Harar, Ethiopia.
| | - Xenia Dolja-Gore
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Julie Byles
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia
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Khou V, Ly A, Moore L, Markoulli M, Kalloniatis M, Yapp M, Hennessy M, Zangerl B. Review of referrals reveal the impact of referral content on the triage and management of ophthalmology wait lists. BMJ Open 2021; 11:e047246. [PMID: 34493511 PMCID: PMC8424861 DOI: 10.1136/bmjopen-2020-047246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Many chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a public hospital-based integrated eye care model, this study aims to evaluate the quality of referrals for new patients through information content, assess triage decisions of newly referred patients and evaluate the consistency of referral content for new patients referred multiple times. DESIGN A retrospective and prospective review of all referral forms for new patients referred to a public hospital ophthalmology clinic between January 2016 and September 2017, and September 2017 and August 2018, respectively. SETTING A referral-only public hospital ophthalmology clinic in metropolitan Sydney, Australia. PARTICIPANTS 418 new patients on existing non-urgent wait lists waiting to be allocated an initial appointment, and 528 patients who were newly referred. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the information content of referrals for new patients. The secondary outcomes were triage outcomes for new incoming referrals, and the number of new patients with multiple referrals. RESULTS Of the wait-listed referrals, 0.2% were complete in referral content compared with 9.8% of new incoming referrals (p<0.001). Of new incoming referrals, 56.7% were triaged to a non-urgent clinic. Multiple referrals were received for 49 patients, with no change in the amount of referral content. CONCLUSIONS Most referrals were incomplete in content, leading to triage based on limited clinical information. Some new patients were referred multiple times with their second referral containing a similar amount of content as their first. Lengthy wait lists could be prevented by improving administrative processes and communication between the referral centre and referrers. The future implementation of an integrated eye care model at the study setting could sustainably cut wait lists for patients with chronic eye conditions.
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Affiliation(s)
- Vincent Khou
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lindsay Moore
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Yapp
- Centre for Eye Health, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Hennessy
- Centre for Eye Health, Sydney, New South Wales, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Coronary Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Wang H, Kalloniatis M. Clinical outcomes of the Centre for Eye Health: an intra-professional optometry-led collaborative eye care clinic in Australia. Clin Exp Optom 2021; 104:795-804. [PMID: 33689627 DOI: 10.1080/08164622.2021.1878821] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clinical relevance: This novel clinical model is the first of its kind in Australia and was designed to help reduce unnecessary referrals into overburdened public systems by utilising pre-existing community-based resources.Background: The Centre for Eye Health (CFEH) is an intra-professional optometry-led care clinic offering an alternative pathway to traditional ophthalmology-based pathways (public hospital clinics or private practices) for 'at-risk' patients requiring ocular imaging, diagnostic and management services. This study evaluates the CFEH integrated eye-care model in the identification of chronic eye diseases within the community.Methods: A retrospective random clinical audit of over 750 medical records of patients referred to the CFEH between July 2016 and June 2019 was conducted. Demographics of patients, referral type, final diagnosis and recommended management plans were extracted from this subset. Clinic key performance indicators (referral turnaround time, and net cost per patient appointment) were also extracted.Results: Of the 755 referrals associated with the audited records, 77.4% resulted in the identification of patients with or at-risk of developing eye diseases with 73.5% of this cohort requiring ongoing monitoring at CFEH or referral to ophthalmology. Although the CFEH model is not designed to diagnose or manage acute conditions, 1.5% of patients in this pathway required same day ophthalmological or medical intervention. The cost per patient was equivalent to hospital eye departments costs.Conclusion: This integrated care pathway has the potential to reduce unnecessary referrals from optometrists to hospital ophthalmological service by offering a safe and effective alternate pathway. The majority of patients seen within this pathway were able to be monitored within optometry-led services. This is a unique clinical model utilising inter-professional referrals within optometry which has the potential to reduce preventable blindness within the community through the early detection of eye diseases.
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Affiliation(s)
- Henrietta Wang
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Rathnayake D, Clarke M. The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review. BMC Health Serv Res 2021; 21:155. [PMID: 33596882 PMCID: PMC7887721 DOI: 10.1186/s12913-021-06140-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/01/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. METHODS We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. RESULTS The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. CONCLUSIONS The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.
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Affiliation(s)
- Dimuthu Rathnayake
- Center for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Mike Clarke
- Center for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Science Block A, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK
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Chang KYJ, Rogers K, Lung T, Shih S, Huang-Lung J, Keay L. Population-Based Projection of Vision-Related Disability in Australia 2020 - 2060: Prevalence, Causes, Associated Factors and Demand for Orientation and Mobility Services. Ophthalmic Epidemiol 2021; 28:516-525. [PMID: 33472491 DOI: 10.1080/09286586.2021.1875009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To project the prevalence, causes, associated factors of vision-related disability and demand for orientation and mobility (O&M) services in Australia from 2020 to 2060. METHODS The age-specific prevalence and main causes of vision-related disability were estimated based on primary data of 74,862 participants in 2015 Survey of Disability, Ageing and Carers. Logistic regression analyses were performed to identify associated factors for the outcome variables including vision-related disability, cataract, macular degeneration and glaucoma. Future prevalence of vision-related disability and demand for O&M services were forecasted using the population projections by the Australian Bureau of Statistics through 2060. RESULTS The main causes of vision-related disability are non-specific sight loss, cataracts, macular degeneration and glaucoma. Health-related associations for vision-related disability are older age, having a history of stroke, having diabetes, depression, heart disease and hearing impairment. The number of Australians with vision-related disability (283,650, 1.10%) and demand for O&M services (123,317, 0.48%) in 2020 will increase to 559,161 (1.38%) and 237,694 (0.59%) respectively in 2060. CONCLUSIONS The number of people with vision-related disability and in need of O&M services in Australia will grow exponentially over the coming decades. General health promotion and specific strategies of early detection and timely treatments of the major eye diseases may ameliorate the trend in vision-related disability.
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Affiliation(s)
- Kuo-Yi Jade Chang
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kris Rogers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Thomas Lung
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sophy Shih
- Surveillance, Evaluation and Research Program, Kirby Institute, University of New South Wales, Sydney, Australia.,Deakin Health Economics, Institute of Health Transformation, Deakin University, Melbourne, Australia
| | - Jessie Huang-Lung
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Lisa Keay
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Ford B, Keay L, Angell B, Hyams S, Mitchell P, Liew G, White A. Quality and targeting of new referrals for ocular complications of diabetes from primary care to a public hospital ophthalmology service in Western Sydney, Australia. Aust J Prim Health 2020; 26:293-299. [PMID: 32659209 DOI: 10.1071/py20084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/04/2020] [Indexed: 01/03/2023]
Abstract
Patients with diabetes require regular examination for eye disease, usually in primary care settings. Guidelines recommend patients with at least moderate non-proliferative diabetic retinopathy (NPDR) be referred to an ophthalmologist for treatment; however, poorly targeted referrals lead to access blocks. The quality of new referrals associated with diabetes to a public ophthalmology service in Sydney, New South Wales, Australia, were assessed for referral completeness and targeting. A cross-sectional audit of medical records for new patients referred to Westmead Hospital Eye Clinic in 2016 was completed. Completeness of medical and ophthalmic information in referrals and subsequent patient diagnosis and management in 2016-17 was recorded. Sub-analyses were conducted by primary care referrer type (GP or optometrist). In total, 151 new retinopathy referrals were received; 12% were sent directly to a treatment clinic. Information was incomplete for diabetes status (>60%), medical (>50%) and ophthalmic indicators (>70%), including visual acuity (>60%). GP referrals better recorded medical, and optometrists (37%) ophthalmic information, but information was still largely incomplete. Imaging was rarely included (retinal photos <1%; optical coherence tomography <3%). Median appointment wait-time was 124 days; 21% of patients received treatment (laser or anti-vascular endothelial growth factor) at this or the following encounter. Targeting referrals for ocular complication of diabetes to public hospitals needs improvement. Education, feedback and collaborative care mechanisms should be considered to improve screening and referral in primary care.
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Affiliation(s)
- Belinda Ford
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW 2042, Australia; and Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia; and Corresponding author.
| | - Lisa Keay
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW 2042, Australia; and School of Optometry and Vision Science, Faculty of Science, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Blake Angell
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW 2042, Australia
| | - Stephanie Hyams
- Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia
| | - Paul Mitchell
- Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia; and Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia
| | - Gerald Liew
- Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia; and School of Optometry and Vision Science, Faculty of Science, UNSW Sydney, Sydney, NSW 2052, Australia; and Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia
| | - Andrew White
- Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia; and School of Optometry and Vision Science, Faculty of Science, UNSW Sydney, Sydney, NSW 2052, Australia; and Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia
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Improving Patient Access and Reducing Costs for Glaucoma with Integrated Hospital and Community Care: A Case Study from Australia. Int J Integr Care 2019; 19:5. [PMID: 31749669 PMCID: PMC6838764 DOI: 10.5334/ijic.4642] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Glaucoma, a chronic eye disease requires regular monitoring and treatment to prevent vision-loss. In Australia, most public ophthalmology departments are overburdened. Community Eye Care is a ‘collaborative’ care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. C-EYE-C was implemented at one Australian hospital. This study aims to determine whether C-EYE-C improves access to care and better utilises resources, compared to hospital-based care. Methods: A clinical and financial audit was conducted to compare access to care and health system costs for hospital care and C-EYE-C. Attendance, wait-time, patient outcomes, and the average cost per encounter were calculated. A weighted kappa assessed agreement between the optometrist and ophthalmologist decisions. Results: There were 503 low-risk referrals, hospital (n = 182) and C-EYE-C (n = 321). C-EYE-C had higher attendance (81.6% vs 68.7%, p = 0.001); and shorter appointment wait-time (89 vs 386 days, p < 0.001). Following C-EYE-C, 57% of patients avoided hospital; with 39% requiring glaucoma management. C-EYE-C costs were 22% less than hospital care. There was substantial agreement between optometrists and ophthalmologist for diagnosis (k = 0.69, CI 0.61–0.76) and management (k = 0.66, CI 0.57–0.74). Discussion: C-EYE-C showed higher attendance, and reduced wait-times and health system costs. Conclusions: Upscale of the C-EYE-C model should be considered to further improve capacity of public eye services in Australia.
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Ho KC, Tran J, Hoang D, Kaushik S, Ford B, Palagyi A, Do VQ, Stapleton F, White A, Keay L. Standardising the cataract referral process for public hospitals: perspectives of optometrists in New South Wales, Australia. Clin Exp Optom 2019; 103:201-206. [PMID: 31218754 DOI: 10.1111/cxo.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/04/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Previous research has shown that cataract surgery referral letters to major metropolitan public hospitals in New South Wales have insufficient detail to inform patient triage or apply prioritisation tools. This study aimed to canvass the views of optometrists working in New South Wales and the Australian Capital Territory (NSW/ACT) on standardising the referral process for public hospital cataract surgery. METHODS An online survey was sent to all NSW/ACT members of Optometry Australia in October 2017. Respondents were asked to select clinical and personal information to be included on a referral template using a list of 25 items. Data were also gathered on preferences for the cataract referral process and sources of cataract referral guidelines. RESULTS Two hundred and thirteen (response rate 13 per cent) optometrists completed the survey. There was close to universal support for inclusion of items like visual acuity (99 per cent), whereas other items had low support, including the date and details of previous refraction (26 per cent), history of falls (29 per cent) and health insurance status (29 per cent). Three-quarters of optometrists stated they would be willing to administer and report data from a patient survey about the functional impact of their cataract and level of visual disability. The preferred format of a standardised cataract referral template varied, although time efficiency and ease of completion were commonly cited reasons for preferences. Confirmation of receipt of referral from the public hospital, and a copy of the referral letter for the optometrist's records were also desirable. For the 61 per cent of respondents who reported accessing guidelines for cataract referral, 69 per cent stated the main source was Optometry NSW/ACT with fewer accessing guidelines directly from a public hospital or the NSW Health website. CONCLUSION Optometrists' preferences will be useful to inform the design and implementation of a standardised cataract referral template.
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Affiliation(s)
- Kam Chun Ho
- Injury Division, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Tran
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Duyen Hoang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shweta Kaushik
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia.,Neuroscience and Vision Division, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Belinda Ford
- Injury Division, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience and Vision Division, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Anna Palagyi
- Injury Division, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Vu Quang Do
- Injury Division, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew White
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia.,Neuroscience and Vision Division, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- Injury Division, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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