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Green S, Ng RJ, Phillips G, Gosling D, Patel HY. Glaucoma Agreement in New Zealand (GAINZ). Clin Exp Optom 2024; 107:204-212. [PMID: 38166354 DOI: 10.1080/08164622.2023.2291063] [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: 10/13/2022] [Accepted: 11/25/2023] [Indexed: 01/04/2024] Open
Abstract
CLINICAL RELEVANCE With an ageing population, ophthalmologists are becoming burdened with glaucoma management, and patient care can be delayed. Therefore, the use of optometrists in glaucoma management can help alleviate the burden. BACKGROUND The ageing population and subsequent rise of glaucoma prevalence are putting a strain on the public health system in New Zealand. Glaucoma collaborative care between optometrists and ophthalmologists has been gaining support with the aim to reduce this burden on ophthalmologists. There has been little investigation of the agreement in care and management of mild-to-moderate severity glaucoma patients by optometrists and ophthalmologists. METHODS One hundred and three glaucomatous eyes were used in a survey where clinical history and examination, intraocular pressures (IOPs), visual field testing and optical coherence tomography (OCT) imaging were evaluated for glaucoma progression and decision-making regarding subsequent management by four participants. Two participants were glaucoma-credentialled optometrists (Group 1), and the other two were glaucoma specialists (Group 2). RESULTS With respect to glaucoma progression, Spearman coefficients identified strong agreement between the two groups for IOP, visual fields and overall status and moderate agreement for OCT imaging. A confusion matrix was used to analyse management and found 80% ± 10% agreement between the two groups. Review periods gave an agreement of 55% ± 20% between the two groups. CONCLUSION There was strong agreement in the assessment of glaucoma progression between the two groups. The 80% level of agreement for subsequent management between the two groups is comparable to other published reports. These results provide some reassurance that a collaborative care system can perform safely and as intended.
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Affiliation(s)
- Stephanie Green
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Robert J Ng
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Geraint Phillips
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Daniel Gosling
- Department of Ophthalmology, Te Whatu Ora Health New Zealand (Northern Region), Auckland, New Zealand
| | - Hussain Y Patel
- New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Te Whatu Ora Health New Zealand (Northern Region), Auckland, New Zealand
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Khachatryan N, Giloyan A, Paduca A, Limburg H, Petrosyan V. Nationwide Rapid Assessment of Avoidable Blindness (RAAB) in Armenia. Ophthalmic Epidemiol 2024; 31:62-69. [PMID: 36872562 DOI: 10.1080/09286586.2023.2187068] [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: 02/04/2022] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. METHODS The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants' demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. RESULTS Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0-2.1), 1.6% (95% CI: 1.0-2.2) and 6.6% (95% CI: 5.5-7.7), respectively.The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. CONCLUSION The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia.
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Affiliation(s)
- Naira Khachatryan
- Garo Meghrigian Institute for Preventive Ophthalmology, Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Aida Giloyan
- Garo Meghrigian Institute for Preventive Ophthalmology, Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Ala Paduca
- Faculty of Medicine, State University of Medicine and Pharmacy "Nicolae Testemiteanu", Chişinău, Republic of Moldova
| | - Hans Limburg
- Health Information Services, Grootebroek, The Netherlands
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
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Hou CH, Shih SF, Pu C. Adherence of those With Self-Reported Glaucoma in the United States to Eye Examination Visits. J Glaucoma 2023; 32:885-890. [PMID: 36971614 DOI: 10.1097/ijg.0000000000002213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
PRCIS The adherence of American patients with self-reported glaucoma to the follow-up recommendations is extremely low. Estimated adherence rate is lower than that obtained by previous studies that did not use a US nationally representative sample. PURPOSE To evaluate adherence to ophthalmic outpatient follow-up visits and vision examinations in the American population aged 40 years or above. METHODS The percentage of American patients aged≥40 years who adhered to glaucoma treatment guidelines was estimated using 2015-2019 Medical Expenditure Panel Survey (MEPS) data. Adherence was defined according to the International Council of Ophthalmology guidelines. We also compared individuals with and without self-reported glaucoma who have made at least one ophthalmic outpatient visit and at least 1 vision examination visit within a year. Differences in means and percentages were estimated to account for the covariance due to the complex sampling design. RESULTS Approximately 4.4 million people aged or above 40 years had self-reported glaucoma in 2019 (3.21%). The rate of prevalence significantly differed with race, with Black people having the highest prevalence in all studied years. Only 7.1% (95% CI: 0.049-0.102) and 2.67% (95% CI: 0.0137-0.0519) of this population underwent at least 1 ophthalmic outpatient examination or 1 vision examination per year. Older age, never married status, higher education, eye conditions, and diabetes were significantly associated with a higher probability of ophthalmic health care use. CONCLUSIONS Adherence to follow-up among patients with self-reported glaucoma in this population-level study was lower than that in previously reported American, non-nationally representative studies. Barriers to adherence at the population level should be assessed to inform the design of future policy or program interventions.
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Affiliation(s)
- Chiun-Ho Hou
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, China
| | - Shu-Fang Shih
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University
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Hamid S, Minakaran N, Igwe C, Baneke A, Pedersen M, Mathew RG. An online glaucoma educational course for patients to facilitate remote learning and patient empowerment. BMJ Health Care Inform 2023; 30:e100748. [PMID: 37620107 PMCID: PMC10450125 DOI: 10.1136/bmjhci-2023-100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
In both face-to-face and teleophthalmology glaucoma clinics, there are significant time constraints and limited resources available to educate the patient and their carers regarding the glaucoma condition. Glaucoma patients are often not satisfied with the content and amount of information they receive and have demonstrated a substantial lack of knowledge regarding their condition. Innovative educational tools that facilitate accessible digital remote patient education can be a powerful adjunct to empower patients in becoming healthcare partners.We describe the development of a free, comprehensive, multimodal online glaucoma patient education course for adults with glaucoma, their family and friends and carers, with the aim of providing a readable resource to aid remote learning and understanding of the condition.The working group for the development of the course comprised of consultants, medical practitioners and education specialists and expert patients. Given the specialised nature of ophthalmology and glaucoma, certain aspects can be difficult to conceptualise, and, therefore, clear and adequate explanations of concepts are provided in the course using diagrams, flow charts, medical illustrations, images, videos, written text, analogies and quizzes.The course is available in a short and long version to suit different learning needs which take approximately 2 hours and 10 hours to complete respectively. The contents list allows course takers to find sections relevant to them and it can be taken anywhere, as long as there is Internet access.We invite you to share this resource with your patients and their families, friends and carers.
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Affiliation(s)
- Sana Hamid
- Glaucoma, Moorfields Eye Hospital City Road Campus, London, UK
| | | | - Chinedu Igwe
- Moorfields Eye Hospital City Road Campus, London, UK
| | - Alex Baneke
- Moorfields Eye Hospital City Road Campus, London, UK
| | | | - Rashmi G Mathew
- Institute of Ophthalmology, University College London, London, UK
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Karthikeyan A, Lee CN, Myneni J, Harthan S, Bragg K, Bentley S, Dubois V, Bhan A. Three-year outcomes of an optometrist-led virtual clinic for new glaucoma referrals. Ophthalmic Physiol Opt 2023. [PMID: 36930523 DOI: 10.1111/opo.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION The purpose of this study was to describe and evaluate the outcomes of an optometrist-led virtual glaucoma clinic (VGC). METHODS New patients referred to the glaucoma service who were consultant triaged as 'low risk' were assessed virtually by specialist-trained optometrists in the VGC and either discharged or monitored for a period of 3 years. Ten percent of virtual case notes were audited by a glaucoma consultant to verify quality and generate learning objectives. Retrospective case-note review and analysis of all patients seen in the virtual clinic between 2014 and 2016 was undertaken to determine 3-year outcomes. RESULTS A total of 1710 new patients were seen in the clinic between 1 January 2014 and 31 December 2016. Of these, 1033 (60.4%) patients required no outpatient input in 3 years of follow-up. Additionally, 320 (18.7%) were discharged at the first visit, and the proportion of glaucoma suspect and ocular hypertension patients who converted to glaucoma was 12.1% and 5.8%, respectively. At 3 years, 95 patients had died, 159 were lost to follow-up, 576 were discharged and 371 were diagnosed with glaucoma at baseline or during the 3-year follow-up. The cumulative discharge proportion from the service at the end of 3 years was 82.6%. No patients required emergency eye treatment or sight-impairment registration, and of the 12 referred back to the clinic on discharge, only five required ongoing monitoring. CONCLUSION This optometrist-led VGC combined two aspects of novel service delivery to reduce the burden of glaucoma monitoring in outpatient departments and consolidate consultant contact to patients requiring more intervention. This model will be of value in units establishing virtual services and looking to expand the role of allied health professionals.
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Affiliation(s)
| | - Chan Ning Lee
- Ophthalmology Department, Liverpool University Foundation Trust, Liverpool, UK
| | - Jaya Myneni
- Ophthalmology Department, Liverpool University Foundation Trust, Liverpool, UK
| | - Stephen Harthan
- Ophthalmology Department, Liverpool University Foundation Trust, Liverpool, UK
| | - Kris Bragg
- Ophthalmology Department, Liverpool University Foundation Trust, Liverpool, UK
| | - Sarah Bentley
- Ophthalmology Department, Liverpool University Foundation Trust, Liverpool, UK
| | - Vincent Dubois
- Ophthalmology Department, Liverpool University Foundation Trust, Liverpool, UK
| | - Anna Bhan
- Ophthalmology Department, Liverpool University Foundation Trust, Liverpool, UK
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Maurin R, Deltetto I, Keay L, Huang-Lung J, Taylor C. Feasibility of providing collaborative glaucoma care from a community optometry perspective: a mixed-methods assessment. Clin Exp Optom 2023; 106:171-177. [PMID: 36857734 DOI: 10.1080/08164622.2023.2175602] [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: 03/03/2023] Open
Abstract
CLINICAL RELEVANCE Despite evidence showing that optometry-led collaborative glaucoma care can be delivered at reduced cost compared to ophthalmology-based care without compromising patient outcomes, such models of care are not widely practiced in Australia. Ensuring glaucoma patients have equitable access to effective and cost-effective care is a matter of public health importance. BACKGROUND This study examined the feasibility and business case assessment for providing glaucoma care from a community optometry perspective. METHODS Nine optometrists were interviewed in a semi-structured format, focusing on the economic feasibility, barriers, and benefits of collaborative glaucoma care. The Consolidated Framework for Intervention Research was used for thematic data analysis. Costs and revenues associated with providing glaucoma care were sourced from the literature and interviews. A business case model assessing the profitability of glaucoma care in optometric practice was developed. RESULTS Thematic analysis revealed concerns over financial viability such that current Medicare Benefits Schedule fees are not sufficient to justify the cost of running a community optometry glaucoma clinic. All participants received a supplementary source of revenue. This finding was confirmed by the business case assessment. Inter-professional trust was perceived to be a key barrier to initiation of collaborative care however was able to be overcome quickly upon commencement of a collaborative care relationship. Optometrists perceived that collaborative care was beneficial to all involved, including patients, ophthalmologists, optometrists, and health payers. There was a perception of a growing divide between clinical and retail optometry, which was thought by most participants to be appropriate. CONCLUSION This study is the first to explore the feasibility and business case for community-based optometrists to provide collaborative glaucoma care in Australia. Our findings show that current public funding is insufficient to justify the business case to private optometry practice, despite being perceived by optometrists as beneficial to all involved.
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Affiliation(s)
| | | | - Lisa Keay
- School of Optometry and Vision Science, UNSW, Sydney, Australia
| | | | - Colman Taylor
- HTANALYSTS, Sydney, Australia.,Critical care, The George Institute for Global Health, Sydney, Australia
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Mushtaq Y, Panchasara B, Nassehzadehtabriz N, Lim HK, Mushtaq M, Kean J, Farrell S, Bourne RRA, Shahid H, Khatib TZ, Martin KR. Evaluating multidisciplinary glaucoma care: visual field progression and loss of sight year analysis in the community vs hospital setting. Eye (Lond) 2022; 36:555-563. [PMID: 33746209 PMCID: PMC7982276 DOI: 10.1038/s41433-021-01492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/30/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A variety of shared care models have been developed, which aim to stratify glaucoma patients according to risk of disease progression. However, there is limited published data on the rate of glaucoma progression in the hospital vs community setting. Here we aimed to compare rates of glaucomatous visual field progression in the Cambridge Community Optometrist Glaucoma Scheme (COGS) and Addenbrooke's Hospital Glaucoma Clinic (AGC). METHODS A retrospective comparative cohort review was performed. Patients with five or more visual field tests were included. Zeiss Forum software was used to calculate the MD progression rate (dB/year). Loss of sight years (LSY) were also calculated for both COGS and AGC. RESULTS Overall, 8465 visual field tests from 854 patients were reviewed. In all, 362 eyes from the AGC group and 210 eyes from COGS were included. The MD deterioration rate was significantly lower in the COGS patients compared with the AGC group (-0.1 vs -0.3 dB/year; p < 0.0001). No patients in the COGS group were predicted to become blind within their lifetime by LSY analysis. Fifteen patients were at risk in the AGC group. CONCLUSION This service evaluation shows that COGS is an effective scheme to stratify lower risk glaucoma patients, increasing the capacity within hospital eye services. COGS patients have a lower rate of visual field deterioration compared to AGC patients. Effective communication between community and tertiary schemes is essential to facilitate transfer of patients requiring further hospital management reliably and efficiently, with the potential for low-risk patients to be followed safely in the community.
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Affiliation(s)
- Yusuf Mushtaq
- Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Binita Panchasara
- Eye Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maryam Mushtaq
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jane Kean
- Eye Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sarah Farrell
- Eye Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rupert R A Bourne
- Eye Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Humma Shahid
- Eye Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tasneem Z Khatib
- Eye Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Keith R Martin
- Eye Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia.
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
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Lakhani BK, Giannouladis K, Leighton P, Spry PGD, Harper RA, King AJ. Defining stable glaucoma: a Delphi consensus survey of UK optometrists with a specialist interest in Glaucoma. Eye (Lond) 2021; 35:2524-2534. [PMID: 33177657 PMCID: PMC8376980 DOI: 10.1038/s41433-020-01251-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Increasing demand on hospital services has led to the development of alternative community-based services, often run by optometrists for monitoring 'stable' and low-risk glaucoma patients. METHODS An online Delphi exercise was undertaken to derive a consensus definition of 'stable glaucoma' amongst optometrists with a special interest in glaucoma. Participants were asked to score their agreement for various clinical parameters. Results from each round were used to inform subsequent rounds. RESULTS 31 optometrists participated in the study. 100%, 77%, and 68% completion rates were achieved over three rounds respectively. Consensus was reached for 7 parameters: Stability should be defined over a period of 36-48 months, summary measure Visual Field (VF), and/or Trend Analysis should be used to assess VF stability. Two or more decibel (dB) of change of VF mean deviation (MD) is considered unstable. Intraocular pressure (IOP) should be below a target defined by the patient's clinician or a fixed-percentage reduction compared to the presenting IOP. No treatment change during the stability assessment period is considered stable. Imaging with Ocular Coherence Topography Retinal Nerve Fibre Layer (OCT RNFL) assessment should be used to define glaucoma stability. Overview by a glaucoma consultant was considered important for glaucoma monitoring schemes. CONCLUSION This Delphi exercise has generated a consensus definition for glaucoma stability by UK Optometrists with a specialist interest in glaucoma. This consensus definition can be used to inform the selection of suitable patients from hospital services for transfer to monitoring in community-based 'stable' optometry run glaucoma clinics.
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Affiliation(s)
- Bansri K Lakhani
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Konstantinos Giannouladis
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Kings Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK
| | - Paul G D Spry
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, BS1 2LX, UK
| | - Robert A Harper
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Anthony J King
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
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Kassam F, Sogbesan E, Boucher S, Rudnisky CJ, Prince W, Leinweber G, Pilipchuk T, Kogan S, Edwards MC, Dorey MW, Damji KF. Collaborative care and teleglaucoma: a novel approach to delivering glaucoma services in Northern Alberta, Canada. Clin Exp Optom 2021; 96:577-80. [DOI: 10.1111/cxo.12065] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Faazil Kassam
- Division of Ophthalmology, University of Calgary, Calgary, AB, Canada,
| | - Enitan Sogbesan
- St Joseph's HealthCare / Hamilton Health Sciences and Division of Ophthalmology, McMaster University, Hamilton, ON, Canada,
| | | | | | | | | | | | - Sylvia Kogan
- Department of Ophthalmology, University of Manitoba, Winnipeg, MB, Canada,
| | - Marianne C Edwards
- Department of Ophthalmology, University of Alberta, Edmonton, AB, Canada,
| | - Michael W Dorey
- Department of Ophthalmology, University of Alberta, Edmonton, AB, Canada,
| | - Karim F Damji
- Department of Ophthalmology, University of Alberta, Edmonton, AB, Canada,
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Abstract
Purpose: We assessed a novel, public, vertical integrated care model for glaucoma management in the community. Methods: This study was a retrospective, longitudinal study of 266 patients diagnosed or suspected of glaucoma. Patients were stratified to either ongoing ophthalmology-led (n = 81) or optometry-led shared care (n = 185). Demographics and clinical characteristics, including the re-referral rate and timeliness of follow up were analysed. Results: Just under half (565/1224, 46%) of all follow up consultations over the total study period of 45 months were seen in optometry-led care, with a re-referral rate to ophthalmology of 21%. Treated patients showed a median intraocular pressure reduction of 20% and a median time delay of just two days between the actual and recommended review period. Conclusions: Shared care provides an effective option for managing the ongoing care burden in chronic stable glaucoma cases at low risk of vision loss.
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Kelly SR, Khawaja AP, Bryan SR, Azuara-Blanco A, Sparrow JM, Crabb DP. Progression from ocular hypertension to visual field loss in the English hospital eye service. Br J Ophthalmol 2020; 104:1406-1411. [PMID: 32217541 DOI: 10.1136/bjophthalmol-2019-315052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/03/2019] [Accepted: 12/19/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND There are more than one million National Health Service visits in England and Wales each year for patients with glaucoma or ocular hypertension (OHT). With the ageing population and an increase in optometric testing, the economic burden of glaucoma-related visits is predicted to increase. We examined the conversion rates of OHT to primary open-angle glaucoma (POAG) in England and assessed factors associated with risk of conversion. METHODS Electronic medical records of 45 309 patients from five regionally different glaucoma clinics in England were retrospectively examined. Conversion to POAG from OHT was defined by deterioration in visual field (two consecutive tests classified as stage 1 or worse as per the glaucoma staging system 2). Cox proportional hazards models were used to examine factors (age, sex, treatment status and baseline intraocular pressure (IOP)) associated with conversion. RESULTS The cumulative risk of conversion to POAG was 17.5% (95% CI 15.4% to 19.6%) at 5 years. Older age (HR 1.35 per decade, 95% CI 1.22 to 1.50, p<0.001) was associated with a higher risk of conversion. IOP-lowering therapy (HR 0.45, 95% CI 0.35 to 0.57, p<0.001) was associated with a lower risk of conversion. Predicted 5-year conversion rates for treated and untreated groups were 14.0% and 26.9%, respectively. CONCLUSION Less than one-fifth of OHT patients managed in glaucoma clinics in the UK converted to POAG over a 5-year period, suggesting many patients may require less intensive follow-up. Our study provides real-world evidence for the efficacy of current management (including IOP-lowering treatment) at reducing risk of conversion.
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Affiliation(s)
- Stephen R Kelly
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and University College London, London, UK
| | - Susan R Bryan
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | | | - John M Sparrow
- Bristol Eye Hospital, Population Health Sciences, University of Bristol, Bristol, UK.,The Royal College of Ophthalmologists National Ophthalmology Database Audit, Royal College of Ophthalmologists, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Agreement in clinical decision-making between independent prescribing optometrists and consultant ophthalmologists in an emergency eye department. Eye (Lond) 2020; 34:2284-2294. [PMID: 32203243 DOI: 10.1038/s41433-020-0839-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The specialty-registration of independent prescribing (IP) was introduced for optometrists in 2008, which extended their roles including into acute ophthalmic services (AOS). The present study is the first since IP's introduction to test concordance between IP optometrists and consultant ophthalmologists for diagnosis and management in AOS. METHODS The study ran prospectively for 2 years at Manchester Royal Eye Hospital (MREH). Each participant was individually assessed by an IP optometrist and then by the reference standard of a consultant ophthalmologist; diagnosis and management were recorded on separate, masked proformas. IP optometrists were compared to the reference standard in stages. Cases of disagreement were arbitrated by an independent consultant ophthalmologist. Cases where disagreement persisted after arbitration underwent consensus-review. Agreement was measured with percentages, and where possible kappa (Κ), for: diagnosis, prescribing decision, immediate management (interventions during assessment) and onward management (review, refer or discharge). RESULTS A total of 321 participants presented with 423 diagnoses. Agreement between all IP optometrists and the staged reference standard was as follows: 'almost perfect' for diagnosis (Κ = 0.882 ± 0.018), 'substantial' for prescribing decision (Κ = 0.745 ± 0.034) and 'almost perfect' for onward management (0.822 ± 0.032). Percentage-agreement between all IP optometrists and the staged reference standard per diagnosis was 82.0% (CI 78.1-85.4%), and per participant using stepwise weighting was 85.7% (CI 81.4-89.1%). CONCLUSIONS Clinical decision-making in MREH's AOS by experienced and appropriately trained IP optometrists is concordant with consultant ophthalmologists. This is the first study to explore and validate IP optometrists' role in the high-risk field of AOS.
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14
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Care pathways for glaucoma detection and monitoring in the UK. Eye (Lond) 2019; 34:89-102. [PMID: 31700149 DOI: 10.1038/s41433-019-0667-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/08/2022] Open
Abstract
Glaucoma presents considerable challenges in providing clinically and cost-effective care pathways. While UK population screening is not seen as justifiable, arrangements for case finding have historically been considered relatively ineffective. Detection challenges include an undetected disease burden, whether from populations failing to access services or difficulties in delivering effective case-finding strategies, and a high false positive rate from referrals via traditional case finding pathways. The enhanced General Ophthalmic Service (GOS) in Scotland and locally commissioned glaucoma referral filtering services (GRFS) elsewhere have undoubtedly reduced false positive referrals, and there is emerging evidence of effectiveness of these pathways. At the same time, it is recognised that implementing GRFS does not intrinsically reduce the burden of undetected glaucoma and late presentation, and obvious challenges remain. In terms of diagnosis and monitoring, considerable growth in capacity remains essential, and non-medical health care professional (HCP) co-management and virtual clinics continue to be important solutions in offering requisite capacity. National guidelines, commissioning recommendations, and the Common Clinical Competency Framework have clarified requirements for such services, including recommendations on training and accreditation of HCPs. At the same time, the nature of consultant-delivered care and expectations on the glaucoma specialist's role has evolved alongside these developments. Despite progress in recent decades, given projected capacity requirements, further care pathways innovations appear mandated. While the timeline for implementing potential artificial intelligence innovations in streamlining care pathways is far from established, the glaucoma burden presents an expectation that such developments will need to be at the vanguard of future developments.
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Creer RC, Roberts SA, Aslam TM, Balaskas K, Chhabra R, Mahmood S, Turner GS, Harper RA. Treatment decisions of UK hospital optometrists and ophthalmologists in patients with nAMD: a vignette study. Ophthalmic Physiol Opt 2019; 39:432-440. [DOI: 10.1111/opo.12644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/12/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Rosalind C Creer
- Manchester Royal Eye Hospital Manchester University NHS Foundation Trust Manchester UK
- Manchester Academic Health Sciences Centre Manchester UK
| | | | - Tariq M Aslam
- Manchester Royal Eye Hospital Manchester University NHS Foundation Trust Manchester UK
- Manchester Academic Health Sciences Centre Manchester UK
- Division of Optometry and Pharmacy University of Manchester Manchester UK
| | - Konstantinos Balaskas
- Manchester Royal Eye Hospital Manchester University NHS Foundation Trust Manchester UK
- Manchester Academic Health Sciences Centre Manchester UK
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital Manchester University NHS Foundation Trust Manchester UK
- Manchester Academic Health Sciences Centre Manchester UK
| | - Sajjad Mahmood
- Manchester Royal Eye Hospital Manchester University NHS Foundation Trust Manchester UK
- Manchester Academic Health Sciences Centre Manchester UK
| | - George S Turner
- Manchester Royal Eye Hospital Manchester University NHS Foundation Trust Manchester UK
- Manchester Academic Health Sciences Centre Manchester UK
| | - Robert A Harper
- Manchester Royal Eye Hospital Manchester University NHS Foundation Trust Manchester UK
- Manchester Academic Health Sciences Centre Manchester UK
- Division of Optometry and Pharmacy University of Manchester Manchester UK
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Abstract
Purpose: While diabetes is a chronic disease, in many health care systems patients with diabetes at risk of diabetic retinopathy (DR) are managed in hospital settings. Aim of this feasibility study is to assess the quality of care and economic benefits of a shared care model managing patients at risk of DR in a primary eye care clinic (PEC) compared with a current tertiary specialist outpatient clinic (SOC). Methods: A randomized trial was performed, to compare a PEC with a SOC in Singapore. The trial patients included those previously seen at the SOC, and having no DR or stable mild non proliferative (NPDR) with no macular edema, no visual and DR deterioration. Primary outcomes were clinical management. Secondary outcomes were patient satisfaction and cost of consultation. Differences analysis used equivalence testing and generalized odds ratios (GOR). Results: The trial included 231 patients, 83.1% classified as no DR (PEC: 79.1%; SOC: 87.1%) and 16.9% as stable mild NPDR (PEC: 20.9%; SOC: 12.9%). DR management at PEC was significantly equivalent to that received at the SOC (rate difference 2.56%; CI: (–1.61% to 6.74%)) and 4.29%; CI: (0.14%–8.45%), respectively. Patient satisfaction at the PEC was equally high when compared to SOC (GOR: 1.71; CI: (0.50–2.00)). Direct costs per patient visit was 45% lower at PEC compared to SOC. Conclusions: Our feasibility trial showed that patients with diabetes with no or stable DR receive similar clinical care and management at a lower-cost PEC setting, are equally satisfied with the service compared to tertiary eye care. A follow-up study is necessary to validate these findings. Managing patients with diabetes at risk of DR at a PEC may be a safe and effective shared care model to improve accessibility for patients while enhancing professional collaboration between hospital and community settings.
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Shared Cared for Stable Glaucoma Patients: Economic Benefits and Patient-centered Outcomes of a Feasibility Trial. J Glaucoma 2019; 27:170-175. [PMID: 29271805 DOI: 10.1097/ijg.0000000000000852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article is to assess the quality of care and economic benefits of a shared care model managing patients with stable glaucoma in a primary eye care (PEC) clinic compared with a tertiary specialist outpatient clinic (SOC) in Singapore. PATIENTS AND METHODS A randomized equivalence feasibility trial was preformed comparing the PEC with SOC models. Participants recruited from the SOC had no visual field progression or change in management for at least 3 years, were on a maximum of a single glaucoma medication, had no previous tube-shunt implant and were at least 3-year posttrabeculectomy surgery.Primary outcomes were clinical assessment and management, economic benefits, and patient satisfaction. Differences were analyzed using equivalence testing and generalized odds ratios. RESULTS The trial included 233 patients, consisting of 42.1% glaucoma disc suspects (PEC: 47.4%; SOC: 36.8%), 27.5% primary angle closure suspects (PEC: 25.0%; SOC: 29.9%), 13.7% with ocular hypertension (PEC: 13.8%; SOC: 13.7%), 3.9% with primary angle closure glaucoma (PEC: 4.3%; SOC: 3.4%), and 3.0% with primary open angle glaucoma (PEC: 1.7%; SOC: 4.3%). Glaucoma clinical care for patients at PEC was as good as SOC [rate difference, 6.83%; 95% confidence interval (CI), 2.84-11.12) and management (rate difference, 7.69%; 95% CI, 3.21-12.17). In 23 cases (9.9%), 5.2% at PEC and 14.5% at SOC, there was disconcordance with the gold standard of senior consultant. Patient satisfaction at the PEC was equally high when compared with SOC (generalized odds ratio, 1.43; CI, 0.50-2.00). Direct costs per patient visit were 43% lower at PEC compared with SOC. CONCLUSION Managing stable glaucoma patients at a primary care setting is a cost saving, safe, and effective shared care while enhancing professional collaboration between hospital and community settings.
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Damento GM, Winkler NS, Hodge DO, Khanna SS, Khanna CL. Healthcare Utilization by Glaucoma Patients in a Team Care Model. Semin Ophthalmol 2018; 33:829-837. [DOI: 10.1080/08820538.2018.1514059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gena M. Damento
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Sunil S. Khanna
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
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20
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Newlands SJ, Hoy BM. Glaucoma patient follow-up time at Waikato Hospital, New Zealand. Clin Exp Ophthalmol 2018; 46:558-560. [DOI: 10.1111/ceo.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Samuel J Newlands
- Department of Ophthalmology; Hauora Tairawhiti; Gisborne New Zealand
| | - Benjamin M Hoy
- Department of Ophthalmology; Waikato District Health Board; Hamilton New Zealand
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Labiris G, Panagiotopoulou EK, Kozobolis VP. A systematic review of teleophthalmological studies in Europe. Int J Ophthalmol 2018; 11:314-325. [PMID: 29487825 PMCID: PMC5824090 DOI: 10.18240/ijo.2018.02.22] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/08/2017] [Indexed: 11/23/2022] Open
Abstract
A systematic review of the recent literature regarding a series of ocular diseases involved in European telemedicine projects was performed based on the PubMed, Google Scholar and Springer databases in June 2017. Literature review returned 44 eligible studies; among them, emergency ophthalmology, diabetic retinopathy, glaucoma, age-related macular disease, cataract and retinopathy of prematurity. The majority of studies indicate teleophthalmology as a valid, reliable and cost-efficient method for care-provision in ophthalmology patients which delivers comparable outcomes to the traditional examination methods.
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Affiliation(s)
- Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis 68100, Greece
- Eye Institute of Thrace, Alexandroupolis 68100, Greece
| | | | - Vassilios P. Kozobolis
- Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, Alexandroupolis 68100, Greece
- Eye Institute of Thrace, Alexandroupolis 68100, Greece
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Reeves BC, Scott LJ, Taylor J, Hogg R, Rogers CA, Wordsworth S, Townsend D, Muldrew A, Peto T, Violato M, Dakin H, Cappel-Porter H, Mills N, O'Reilly D, Harding SP, Chakravarthy U. The Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual randomised balanced incomplete block trial. Health Technol Assess 2018; 20:1-120. [PMID: 27809956 DOI: 10.3310/hta20800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with neovascular age-related macular degeneration (nAMD) usually attend regular reviews, even when the disease is quiescent. Reviews are burdensome to health services, patients and carers. OBJECTIVES To compare the proportion of correct lesion classifications made by community-based optometrists and ophthalmologists from vignettes of patients; to estimate the cost-effectiveness of community follow-up by optometrists compared with follow-up by ophthalmologists in the Hospital Eye Service (HES); to ascertain views of patients, their representatives, optometrists, ophthalmologists and clinical commissioners on the proposed shared care model. DESIGN Community-based optometrists and ophthalmologists in the HES classified lesions from vignettes comprising clinical information, colour fundus photographs and optical coherence tomography images. Participants' classifications were validated against experts' classifications (reference standard). SETTING Internet-based application. PARTICIPANTS Ophthalmologists had to have ≥ 3 years post-registration experience in ophthalmology, have passed part 1 of the Royal College of Ophthalmologists, Diploma in Ophthalmology or equivalent examination, and have experience in the age-related macular degeneration service. Optometrists had to be fully qualified, be registered with the General Optical Council for ≥ 3 years and not be participating in nAMD shared care. INTERVENTIONS The trial sought to emulate a conventional trial in comparing optometrists' and ophthalmologists' decision-making, but vignettes, not patients, were assessed; therefore, there were no interventions. Participants received training prior to assessing vignettes. MAIN OUTCOME MEASURES Primary outcome - correct classification of the activity status of a lesion based on a vignette, compared with a reference standard. Secondary outcomes - frequencies of potentially sight-threatening errors, participants' judgements about specific lesion components, participant-rated confidence in their decisions and cost-effectiveness of follow-up by community-based optometrists compared with HES ophthalmologists. RESULTS In total, 155 participants registered for the trial; 96 (48 in each professional group) completed training and main assessments and formed the analysis population. Optometrists and ophthalmologists achieved 1702 out of 2016 (84.4%) and 1722 out of 2016 (85.4%) correct classifications, respectively [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.66 to 1.25; p = 0.543]. Optometrists' decision-making was non-inferior to ophthalmologists' with respect to the pre-specified limit of 10% absolute difference (0.298 on the odds scale). Frequencies of sight-threatening errors were similar for optometrists and ophthalmologists [57/994 (5.7%) vs. 62/994 (6.2%), OR 0.93, 95% CI 0.55 to 1.57; p = 0.789]. Ophthalmologists assessed lesion components as present less often than optometrists and were more confident about their lesion classifications than optometrists. The mean care-pathway cost for assessment was very similar by group, namely £397.33 for ophthalmologists and £410.78 for optometrists. The optometrist-led monitoring reviews were slightly more costly and less effective than ophthalmologist-led reviews, although the differences were extremely small. There was consensus that optometrist-led monitoring has the potential to reduce clinical workload and be more patient-centred. However, potential barriers are ophthalmologists' perceptions of optometrists' competence, the need for clinical training, the ability of the professions to work collaboratively and the financial feasibility of shared care for Clinical Commissioning Groups. CONCLUSIONS The ability of optometrists to make nAMD retreatment decisions from vignettes is non-inferior to that of ophthalmologists. Various barriers to implementing shared cared for nAMD were identified. FUTURE WORK RECOMMENDATIONS The Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES) study web application was robust and could be used for future training or research. The benefit of reducing HES workload was not considered in the economic evaluation. A framework of programme budgeting and marginal analysis could explicitly explore the resource implications of shifting resources within a given health service area, as the benefit of reducing HES workload was not considered in the economic evaluation. Future qualitative research could investigate professional differences of opinion that were identified in multidisciplinary focus groups. TRIAL REGISTRATION Current Controlled Trials ISRCTN07479761. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 80. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barnaby C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Lauren J Scott
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jodi Taylor
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Ruth Hogg
- Institute of Clinical Science, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daisy Townsend
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alyson Muldrew
- Institute of Clinical Science, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Tunde Peto
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Oxford, Oxford, UK
| | - Helen Dakin
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Heike Cappel-Porter
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Nicola Mills
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Dermot O'Reilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Simon P Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Usha Chakravarthy
- Institute of Clinical Science, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
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Baker H, Ratnarajan G, Harper RA, Edgar DF, Lawrenson JG. Effectiveness of UK optometric enhanced eye care services: a realist review of the literature. Ophthalmic Physiol Opt 2017; 36:545-57. [PMID: 27580754 DOI: 10.1111/opo.12312] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/09/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE UK demographic and legislative changes combined with increasing burdens on National Health Service manpower and budgets have led to extended roles for community optometrists providing locally-commissioned enhanced optometric services (EOS). This realist review's objectives were to develop programme theories that implicitly or explicitly explain quality outcomes for eye care provided by optometrists via EOS and to test these theories by investigating the effectiveness of services for cataract, glaucoma, and primary eye care. METHODS The review protocol was published on PROSPERO, and RAMESES publication standards were followed. Programme theories were formulated via scoping literature searches and expert consultation. The searching process involved all relevant electronic databases and grey literature, without restrictions on study design. Data synthesis focussed on questioning the integrity of each theory by considering supportive and refuting evidence from the source literature. RESULTS Good evidence exists for cataract, glaucoma and primary eye care EOS that: with appropriate training, accredited optometrists manage patients commensurate with usual care standards; genuine partnerships can exist between community and hospital providers for cataract and glaucoma EOS; patient satisfaction with all three types of service is high; cost-effectiveness of services is unproven for cataract and primary eye care, while glaucoma EOS cost-effectiveness depends on service type; contextual factors may influence service success. CONCLUSIONS The EOS reviewed are clinically effective and provide patient satisfaction but limited data is available on cost-effectiveness.
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Affiliation(s)
- Helen Baker
- Division of Optometry and Visual Science, City University London, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Gokulan Ratnarajan
- UCL Institute of Ophthalmology, London, UK.,Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - Robert A Harper
- Manchester Academic Health Sciences Centre, Manchester Royal Eye Hospital, Manchester, UK
| | - David F Edgar
- Division of Optometry and Visual Science, City University London, London, UK
| | - John G Lawrenson
- Division of Optometry and Visual Science, City University London, London, UK
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Calafati J, Pradhan ZS, Birt CM. Frequency of unplanned interventions in patients attending for a presumed routine glaucoma follow-up appointment. Can J Ophthalmol 2016; 51:426-430. [PMID: 27938953 DOI: 10.1016/j.jcjo.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 04/29/2016] [Accepted: 05/16/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the frequency of patient visits in which an unplanned treatment modification was required in chronic patients attending a glaucoma clinic for routine follow-up and to identify the treatment interventions most commonly employed. DESIGN Prospective, cross-sectional study. PARTICIPANTS A total of 630 previously stable patients attending a glaucoma clinic for routine follow-up. METHODS This was a single-centre survey of all eligible patients returning to an academic glaucoma clinic. Data regarding whether patients' visit remained routine or required intervention, which clinical parameter had changed, and any alterations in treatment regimens were studied. RESULTS The percentage of patients found to require a change in management was 20.79% (131 of 630 patients); 16.9% were found to have a cause for change because of glaucoma, and the remaining 4% required intervention because of a nonglaucomatous condition. The most common parameter that changed treatment was intraocular pressure (43.87%), followed by visual fields (21.29%). The frequency of abnormal parameters varied within each subtype of glaucoma. The frequency of treatment changes among those with primary open-angle glaucoma was 22.58% compared with 16.5% of glaucoma suspects, 14% of ocular hypertensives, 32% of pseudoexfoliative glaucoma, and 50% of normal tension glaucoma patients. The most common intervention (32.84%) was a change in antiglaucoma medications. The next most frequent interventions were laser procedures (21.90%) and surgery (16.06%). CONCLUSIONS This study suggests that a significant minority of patients attending a glaucoma clinic for a routine appointment require treatment modification.
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Affiliation(s)
- Jennifer Calafati
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Zia S Pradhan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Catherine M Birt
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
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25
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Lee B. Imaging in glaucoma care pathways in the UK. J Vis Commun Med 2016; 39:33-9. [DOI: 10.1080/17453054.2016.1182139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ansah JP, De Korne D, Bayer S, Pan C, Jayabaskar T, Matchar DB, Lew N, Phua A, Koh V, Lamoureux E, Quek D. Future requirements for and supply of ophthalmologists for an aging population in Singapore. HUMAN RESOURCES FOR HEALTH 2015; 13:86. [PMID: 26578002 PMCID: PMC4650855 DOI: 10.1186/s12960-015-0085-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Singapore's population, as that of many other countries, is aging; this is likely to lead to an increase in eye diseases and the demand for eye care. Since ophthalmologist training is long and expensive, early planning is essential. This paper forecasts workforce and training requirements for Singapore up to the year 2040 under several plausible future scenarios. METHODS The Singapore Eye Care Workforce Model was created as a continuous time compartment model with explicit workforce stocks using system dynamics. The model has three modules: prevalence of eye disease, demand, and workforce requirements. The model is used to simulate the prevalence of eye diseases, patient visits, and workforce requirements for the public sector under different scenarios in order to determine training requirements. RESULTS Four scenarios were constructed. Under the baseline business-as-usual scenario, the required number of ophthalmologists is projected to increase by 117% from 2015 to 2040. Under the current policy scenario (assuming an increase of service uptake due to increased awareness, availability, and accessibility of eye care services), the increase will be 175%, while under the new model of care scenario (considering the additional effect of providing some services by non-ophthalmologists) the increase will only be 150%. The moderated workload scenario (assuming in addition a reduction of the clinical workload) projects an increase in the required number of ophthalmologists of 192% by 2040. Considering the uncertainties in the projected demand for eye care services, under the business-as-usual scenario, a residency intake of 8-22 residents per year is required, 17-21 under the current policy scenario, 14-18 under the new model of care scenario, and, under the moderated workload scenario, an intake of 18-23 residents per year is required. CONCLUSIONS The results show that under all scenarios considered, Singapore's aging and growing population will result in an almost doubling of the number of Singaporeans with eye conditions, a significant increase in public sector eye care demand and, consequently, a greater requirement for ophthalmologists.
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Affiliation(s)
- John P Ansah
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Dirk De Korne
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.
- Institute of Health Policy & Management, Erasmus University Rotterdam, Burg Oudlaan 50, 3000 DR, Rotterdam, Netherlands.
| | - Steffen Bayer
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Chong Pan
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.
| | | | - David B Matchar
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
| | - Nicola Lew
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Andrew Phua
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Victoria Koh
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Ecosse Lamoureux
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
- Singapore Eye Research Institute, 20 College Road, Singapore, 169856, Singapore.
| | - Desmond Quek
- Singapore Eye Research Institute, 20 College Road, Singapore, 169856, Singapore.
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Abstract
PURPOSE Comparing the quality of care provided by a hospital-based shared care glaucoma follow-up unit with care as usual. PATIENTS AND METHODS This randomized controlled trial included stable glaucoma patients and patients at risk for developing glaucoma. Patients in the Usual Care group (n=410) were seen by glaucoma specialists. In the glaucoma follow-up unit group (n=405), patients visited the glaucoma follow-up unit twice followed by a visit to a glaucoma specialist. The main outcome measures were: compliance to the working protocol by glaucoma follow-up unit employees; difference in intraocular pressure between baseline and at ≥18 months; and patient satisfaction. RESULTS Glaucoma follow-up unit employees closely adhered to the working protocol for the measurement of intraocular pressure, visual acuity and GDx (≥97.5% of all visits). Humphrey Field Analyzer examinations were not performed as frequently as prescribed by the working protocol, but more often than in the Usual Care group. In a small minority of patients that required back-referral, the protocol was disregarded, notably when criteria were only slightly exceeded. There was no statistically significant difference in changes in intraocular pressure between the 2 treatment groups (P=0.854). Patients were slightly more satisfied with the glaucoma follow-up unit employees than with the glaucoma specialists (scores: 8.56 vs. 8.40; P=0.006). CONCLUSIONS In general, the hospital-based shared care glaucoma follow-up closely observed its working protocol and patients preferred it slightly over the usual care provided by medical doctors. The glaucoma follow-up unit operated satisfactorily and might serve as a model for shared care strategies elsewhere.
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The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease. Eye (Lond) 2015; 30:68-78. [PMID: 26449197 PMCID: PMC4707499 DOI: 10.1038/eye.2015.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/10/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Standard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions. Methods The Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group. The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists. Discussion This trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.
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Burau V, Bro F. The making of local hospital discharge arrangements: specifying the role of professional groups. BMC Health Serv Res 2015; 15:305. [PMID: 26238863 PMCID: PMC4524021 DOI: 10.1186/s12913-015-0963-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Timely discharge is a key component of contemporary hospital governance and raises questions about how to move to more explicit discharge arrangements. Although associated organisational changes closely intersect with professional interests, there are relatively few studies in the literature on hospital discharge that explicitly examine the role of professional groups. Recent contributions to the literature on organisational studies of the professions help to specify how professional groups in hospitals contribute to the introduction and routinisation of discharge arrangements. This study builds on a view of organisational and professional projects as closely intertwined, where professionals take up organising roles and where organisations shape professionalism. METHODS The analysis is based on a case study of the introduction and routinisation of explicit discharge arrangements for patients with prostate cancer in two hospitals in Denmark. This represents a typical case that involves changes in professional practice without being first and foremost a professional project. The multiple case design also makes the findings more robust. The analysis draws from 12 focus groups with doctors, nurses and secretaries conducted at two different stages in the process of the making of the local discharge arrangements. RESULTS From the analysis, two distinct local models of discharge arrangements that connect more or less directly to existing professional practice emerge: an 'add-on' model, which relies on extra resources, special activities and enforced change; and an 'embedded model', which builds on existing ways of working, current resources, and perspectives of professional groups. The two models reveal differences in the roles of professional groups in terms of their stakes and involvement in the process of organisational change: whereas in the 'add on' model the professional groups remain at a distance, in the 'embedded model' they are closely engaged. CONCLUSIONS In terms of understanding the making of hospital discharge arrangements, the study contributes two sets of insights into the specific roles of professional groups. First, professional interests are an important driver for health professionals to engage in adapting discharge arrangements; and second, professional practice offers a powerful lever for turning new discharge arrangements into organisational routines.
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Affiliation(s)
- Viola Burau
- CFK - Public Health and Quality Improvement, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
- Department of Political Science, Aarhus University, Aarhus N, Denmark.
| | - Flemming Bro
- Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
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Affiliation(s)
- Andrew J R White
- Westmead Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.,Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine M Green
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Melbourne, Victoria, Australia
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Townsend D, Reeves BC, Taylor J, Chakravarthy U, O'Reilly D, Hogg RE, Mills N. Health professionals' and service users' perspectives of shared care for monitoring wet age-related macular degeneration: a qualitative study alongside the ECHoES trial. BMJ Open 2015; 5:e007400. [PMID: 25900465 PMCID: PMC4410127 DOI: 10.1136/bmjopen-2014-007400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore the views of eye health professionals and service users on shared community and hospital care for wet or neovascular age-related macular degeneration (nAMD). METHOD Using maximum variation sampling, 5 focus groups and 10 interviews were conducted with 23 service users and 24 eye health professionals from across the UK (consisting of 8 optometrists, 6 ophthalmologists, 6 commissioners, 2 public health representatives and 2 clinical eye care advisors to local Clinical Commissioning Groups). Data were transcribed verbatim and analysed thematically using constant comparative techniques derived from grounded theory methodology. RESULTS The needs and preferences of those with nAMD appear to be at odds with the current service being provided. There was enthusiasm among health professionals and service users about the possibility of shared care for nAMD as it was felt to have the potential to relieve hospital eye service burden and represent a more patient-centred option, but there were a number of perceived barriers to implementation. Some service users and ophthalmologists voiced concerns about optometrist competency and the potential for delays with referrals to secondary care if stable nAMD became active again. The health professionals were divided as to whether shared care was financially more efficient than the current model of care. Specialist training for optometrists, under the supervision of ophthalmologists, was deemed to be the most effective method of training and was perceived to have the potential to improve the communication and trust that shared care would require. CONCLUSIONS While shared care is perceived to represent a promising model of nAMD care, voiced concerns suggest that there would need to be greater collaboration between ophthalmology and optometry, in terms of interprofessional trust and communication. TRIAL REGISTRATION NUMBER ISRCTN07479761.
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Affiliation(s)
- D Townsend
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - B C Reeves
- School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - J Taylor
- School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - U Chakravarthy
- Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK
| | - D O'Reilly
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast, UK
| | - R E Hogg
- Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK
| | - N Mills
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Zatic T, Bendelic E, Paduca A, Rabiu M, Corduneanu A, Garaba A, Novac V, Curca C, Sorbala I, Chiaburu A, Verega F, Andronic V, Guzun I, Căpăţină O, Zamă-Mardari I. Rapid assessment of avoidable blindness and diabetic retinopathy in Republic of Moldova. Br J Ophthalmol 2014; 99:832-6. [PMID: 25550353 DOI: 10.1136/bjophthalmol-2014-305824] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 11/19/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the prevalence and causes of blindness and visual impairment, the prevalence of diabetes mellitus and diabetic retinopathy among people aged ≥50 years in the Republic of Moldova using Rapid Assessment of Avoidable Blindness plus Diabetic Retinopathy ('RAAB+DR') techniques. MATERIALS AND METHODS 111 communities of people aged ≥50 years were randomly selected. In addition to standard RAAB procedures in all people with diabetes (previous history of the disease or with a random blood glucose level >11.1 mm/L (200 mg/dL)), a dilated fundus examination was performed to assess the presence and the degree of diabetic retinopathy using the Scottish DR grading system. RESULTS 3877 (98%) people out of the 3885 eligible people were examined. The prevalence of blindness was 1.4% (95% CI 1.0% to 1.8%). The major causes of blindness and severe visual impairment were untreated cataract (58.2%), glaucoma (10.9%), and other posterior segment causes (10.9%). The estimated prevalence of diabetes was 11.4%. Among all people with diabetes, 55.9% had some form of retinopathy, and sight threatening diabetic retinopathy affected 14.6%. CONCLUSIONS The RAAB+DR survey in the Republic of Moldova established that untreated cataract is the major cause of avoidable blindness in rural areas. This needs to be tackled by expanding the geographical coverage of cataract surgical services.
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Affiliation(s)
- Tatiana Zatic
- Ministry of Health of the Republic of Moldova, Head of Directorate Primary Care,Chisinău, Republic of Moldova
| | - Eugen Bendelic
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Ala Paduca
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Mansour Rabiu
- International Agency of Prevention of Blindness Eastern Mediterranean region, Riyadh, Saudi Arabia
| | - Angela Corduneanu
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Angela Garaba
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Victoria Novac
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Cristina Curca
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Inga Sorbala
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Andrei Chiaburu
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Florentina Verega
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Victoria Andronic
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Irina Guzun
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Olga Căpăţină
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Iulea Zamă-Mardari
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
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Ting NS, Li Yim JF, Ng JY. Different strategies and cost-effectiveness in the treatment of primary open angle glaucoma. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:523-30. [PMID: 25506233 PMCID: PMC4259865 DOI: 10.2147/ceor.s30697] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Glaucoma is the second highest cause of blindness worldwide with an estimated half of the glaucoma population unaware of their disease. To date, intraocular pressure is the most important modifiable risk factor and lowering it has been proven to reduce progression of visual field loss associated with glaucoma. Different strategies are available to lower intraocular pressure and include medical, laser, or surgical treatment in the form of topical or systemic medications, argon or selective laser trabeculoplasty, and glaucoma drainage surgery such as trabeculectomy, deep sclerectomy, or other drainage devices. The effectiveness of these treatments has been well documented however their cost-effectiveness between the developed world and third world remains unclear.
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Affiliation(s)
| | - James Ft Li Yim
- Department of Ophthalmology, University Hospital Ayr, South Ayrshire, UK
| | - Jia Y Ng
- Department of Ophthalmology, University Hospital Ayr, South Ayrshire, UK ; Faculty of Medicine, University of Glasgow, Glasgow, UK
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Roberts HW, Rughani K, Syam P, Dhingra S, Ramirez-Florez S. The Peterborough Scheme for Community Specialist Optometrists in Glaucoma: Results of 4 Years of a Two-Tiered Community-Based Assessment and Follow-up Service. Curr Eye Res 2014; 40:690-6. [DOI: 10.3109/02713683.2014.957326] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Keenan J, Shahid H, Bourne RR, White AJ, Martin KR. Cambridge community Optometry Glaucoma Scheme. Clin Exp Ophthalmol 2014; 43:221-7. [PMID: 25070417 DOI: 10.1111/ceo.12398] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/15/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. DESIGN The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. PARTICIPANTS 1733 patients were evaluated by this scheme between 2010 and 2013. METHODS Clinical assessment is performed by the optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. MAIN OUTCOME MEASURES The number of false positive referrals from initial referral into the scheme. RESULTS Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. CONCLUSIONS The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system.
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Affiliation(s)
- Jonathan Keenan
- Department of Ophthalmology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Vision and Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, UK
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Hadwin SE, Redmond T, Garway-Heath DF, Lemij HG, Reus NJ, Ward G, Anderson RS. Assessment of optic disc photographs for glaucoma by UK optometrists: the Moorfields Optic Disc Assessment Study (MODAS). Ophthalmic Physiol Opt 2013; 33:618-24. [PMID: 23634792 DOI: 10.1111/opo.12066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/26/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the ability of UK optometrists to accurately discriminate between stereoscopic photographs of healthy and glaucomatous optic discs. METHODS An online survey, including questions relating to qualification, practice environment, and diagnostic methods was completed by 1256 optometrists. Based on their responses, 208 (17%) were selected to undertake an online disc assessment exercise. Optometrists evaluated the same disc images previously assessed by European ophthalmologists as part of the European Optic Disc Assessment Trial (EODAT); the task was to state if the disc appeared healthy or glaucomatous. There were 110 stereoscopic disc images, of which 40 were healthy, 48 glaucomatous, and six ocular hypertensive, with 16 duplicates images. Sensitivity, specificity and overall accuracy were calculated and compared between optometrist groups and with the EODAT ophthalmologists using permutation analysis. RESULTS Median sensitivity was 0.92 (95% CI: 0.70, 1.00) and median specificity was 0.74 (95% CI: 0.62, 0.88). Median overall accuracy was 80% (95% CI: 67%, 88%). Agreement between optometrists was moderate (Fleiss' κ: 0.57). Optometrists with higher qualifications did not have overall higher sensitivity than those without (p = 0.23), but had higher specificity (p = 0.001) and higher overall accuracy (p < 0.001). Optometrists displayed higher sensitivity but lower specificity than the EODAT ophthalmologists. CONCLUSION UK optometrists displayed a high sensitivity and moderate specificity when assessing optic discs for the presence of glaucoma, in the context of this study.
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Affiliation(s)
- Shona E Hadwin
- Optometry Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
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Rahman MQ, Beard SM, Discombe R, Sharma R, Montgomery DMI. Direct healthcare costs of glaucoma treatment. Br J Ophthalmol 2013; 97:720-4. [PMID: 23590855 DOI: 10.1136/bjophthalmol-2012-302525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To report the complete lifetime direct healthcare costs of glaucoma treatment in a database of 1136 patients attending the Glaucoma Clinic at Glasgow Royal Infirmary, Glasgow, UK. METHOD The database was interrogated to identify all patients who had initiated treatment at the Glaucoma Clinic at Glasgow Royal Infirmary, and who had subsequently died of natural causes. The healthcare resource use based cost assessment was based on two aspects of the direct National Health Service cost: drug costs (prescribed medications) and non-drug costs (inpatient or outpatient/and surgical or procedure costs). RESULTS 106 patients (53 men, 53 women) were identified for whom there were lifetime treatment data. The mean lifespan of the patients was 80.5 years, and the mean number of years attending the glaucoma clinic was 7.05 years (range 1-22 years). The mean cost of glaucoma treatment over the lifetime of the patients was £3001, with an annual mean cost per patient of £475. Non-drug and drug costs made up 66% and 34% respectively, of the lifetime costs. CONCLUSIONS This is the only study to directly assess the lifetime treatment costs of glaucoma. Awareness of the costs of glaucoma treatment may be of increased importance in these financially challenging times.
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Affiliation(s)
- M Q Rahman
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
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Holtzer-Goor KM, Plochg T, Lemij HG, van Sprundel E, Koopmanschap MA, Klazinga NS. Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: a qualitative study. Implement Sci 2013; 8:14. [PMID: 23351180 PMCID: PMC3576268 DOI: 10.1186/1748-5908-8-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 01/23/2013] [Indexed: 11/13/2022] Open
Abstract
Background Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders’ perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists. Methods A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis. Results Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU). Respondents’ narratives revealed that: the glaucoma specialists’ sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU. Conclusions Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting) such as this case. Involving the substituting professionals early on to ensure all stakeholders see the change as a normal step in the professionalization of the substituting professionals is essential, as is implementing the task substitution within the window of opportunity.
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Affiliation(s)
- Kim M Holtzer-Goor
- Institute for Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Chawla A, Patel I, Yuen C, Fenerty C. Patterns of adherence to NICE glaucoma guidance in two different service delivery models. Eye (Lond) 2012; 26:1412-7. [PMID: 22935671 PMCID: PMC3496094 DOI: 10.1038/eye.2012.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 04/24/2012] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess adherence patterns to the UK National Institute of Health and Clinical Excellence (NICE) guidelines on glaucoma management (2009) in a tertiary referral centre shared care setting and in a district general hospital (DGH) setting. METHOD We performed a retrospective case note analysis of 200 patients from two centres between January and June 2010. The two centres involved were a consultant-guided teaching hospital optometry-led shared care setting (setting 1) and a consultant-led DGH clinic setting (setting 2). The main outcome measures were compliance with eight of the main NICE guidelines on glaucoma diagnosis and management (2009). RESULTS Both centres showed good adherence to the guidelines regarding the choice of initial treatment (96% vs 100%, settings 1 and 2, respectively) and arranging appropriate monitoring intervals (92% vs 86%). However, significant differences were seen when assessing whether an optic disc image was obtained at the initial visit (74% vs 10%), whether an appropriate initial assessment was performed (96% vs 58%), whether patients' review interval complied with the NICE guidance regardless of hospital cancellations (92% vs 66%), and whether concordance with medication was checked (88% vs 24%) (settings 1 and 2, respectively, P<0.01-Fisher's exact test). CONCLUSION Our study provides evidence to suggest that a hospital-based shared care service with trained optometrists using assessment sheets compares favourably to non-specialist glaucoma care delivered by ophthalmologists.
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Affiliation(s)
- A Chawla
- Manchester Royal Eye Hospital and Manchester Academic and Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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O'Connor PM, Harper CA, Brunton CL, Clews SJ, Haymes SA, Keeffe JE. Shared care for chronic eye diseases: perspectives of ophthalmologists, optometrists and patients. Med J Aust 2012; 196:646-50. [PMID: 22676881 DOI: 10.5694/mja11.10856] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases. DESIGN, SETTING AND PARTICIPANTS Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the Royal Victorian Eye and Ear Hospital in Melbourne during 2007–2009. Semi-structured interviews were conducted with optometrists, ophthalmologists and patients at completion of the project to obtain their perspectives on this model. RESULTS Seventeen optometrists submitted expressions of interest to participate, and 12 completed web-based training modules and clinical observerships and adhered to specified examination and reporting protocols. All five participating ophthalmologists and 11 of the optometrists were interviewed. Ninety-eight patients participated and 37 were interviewed. Optometrists not only met ophthalmologists’ expectations but exceeded them, appropriately detecting and referring patients with additional, previously undetected conditions. Patients reported savings in travel time and were satisfied with the quality of care they received. Optometrists, ophthalmologists and patients indicated a general acceptance of shared care arrangements, although there were some issues relating to interprofessional trust. CONCLUSIONS Shared care between local optometrists and hospital-based ophthalmologists can help to reduce patient waiting time for review and offers an opportunity for these two groups of eye care professionals to collaborate in providing localised care for the benefit of patients. However, trust and relationship building need to be further developed.
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Affiliation(s)
- Patricia M O'Connor
- Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia
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Marks JR, Harding AK, Harper RA, Williams E, Haque S, Spencer AF, Fenerty C. Agreement between specially trained and accredited optometrists and glaucoma specialist consultant ophthalmologists in their management of glaucoma patients. Eye (Lond) 2012; 26:853-61. [PMID: 22498794 PMCID: PMC3376302 DOI: 10.1038/eye.2012.58] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/24/2012] [Indexed: 11/08/2022] Open
Abstract
AIMS Optometrists are becoming increasingly involved in the co-management of glaucoma patients as the burden on the Hospital Eye Service continues to escalate. The aim of this study was to assess the agreement between specially trained optometrists and glaucoma-specialist consultant ophthalmologists in their management of glaucoma patients. METHODS Four optometrists examined 23-25 patients each and the clinical findings, up to the point of dilation, were documented in the hospital records. The optometrist, and one of two consultant ophthalmologists, then independently examined and documented the optic-disc appearance before recording their decisions regarding the stability and management of the patient on a specially designed proforma. Percentage agreement was calculated together with kappa or weighted kappa statistics, where appropriate. RESULTS Agreement between consultants and optometrists in evaluating glaucoma stability was 68.5% (kappa (κ)=0.42-0.50) for visual fields, 64.5% (weighted κ=0.17-0.31) for optic discs, and 84.5% (weighted κ=0.55-0.60) for intraocular pressures. Agreement regarding medical management was 96.5% (κ=0.73-0.81) and for other glaucoma management decisions, including timing of follow-up, referral to a consultant ophthalmologist, and discharge, was 72% (weighted κ=0.65). This agreement increased to 90% following a retrospective independent then consensus review between the two consultants and when qualified agreements were included. Of the 47 glaucoma and non-glaucoma queries generated during the study, 42 resulted in a change of management. CONCLUSION Confirming the ability of optometrists to make appropriate decisions regarding the stability and management of glaucoma patients is essential if their involvement is to continue to develop to meet the demand of an aging population.
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Affiliation(s)
- J R Marks
- Manchester Royal Eye Hospital, Manchester, UK.
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Sharma A, Jofre-Bonet M, Panca M, Lawrenson JG, Murdoch I. An economic comparison of hospital-based and community-based glaucoma clinics. Eye (Lond) 2012; 26:967-71. [PMID: 22562188 DOI: 10.1038/eye.2012.73] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION We have established one model for community care of glaucoma clinic patients. Community optometrists received training and accreditation in glaucoma care. Once qualified they alternated between running half day glaucoma clinics in their own High Street practices and assisting in a hospital-based glaucoma clinic session. This paper reports the cost of this model. METHODS Micro-costing was undertaken for the hospital clinic. A consensus meeting was held to agree costs for community clinics involving all optometrists in the project along with representatives of the multiple chain optometry practices who had participated. Costs to patients both indirect and direct were calculated following structured interviews of 197 patients attending hospital clinics and 194 attending community clinics. RESULTS The estimated cost per patient attendance to the hospital clinic was £63.91 and the estimated cost per attendance to the community clinic was £145.62. For patients the combined direct and indirect cost to attend the hospital clinic was £6.15 and the cost to attend the community clinic £5.91. DISCUSSION The principal reason for the higher cost in the community clinic was higher overhead costs in the community. Re-referral to the hospital system only occurred for 9% of patients and was not a large contribution to the increased cost. Time requested to next appointment was similar for the two clinics. Sensitivity analysis shows a strong effect of increasing patients seen per clinic. It would, however, require 25 patients to be seen per clinician per day in the community in order to make the costs comparable.
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Affiliation(s)
- A Sharma
- Department of Genetics, Institute of Ophthalmology, London, UK.
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Prokofyeva E, Zrenner E. Epidemiology of major eye diseases leading to blindness in Europe: a literature review. Ophthalmic Res 2011; 47:171-88. [PMID: 22123077 DOI: 10.1159/000329603] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 05/18/2011] [Indexed: 12/11/2022]
Abstract
The objective of this work was to study the epidemiology of major eye diseases leading to blindness in Europe through a systematic literature review. The literature search was performed using the Medline database (PubMed), with MeSH and free text search terms. Inclusion criteria for the studies were: (a) performed on a healthy population of Caucasian origin aged between 50 and 75 years; (b) diagnosed by ophthalmological examination in accordance with the International Classification of Diseases 10; (c) contained a detailed description of the sampling and diagnostic procedures and data resources; (d) sample size>500, and (e) published between 1990 and 2008. The results of 57 studies on the prevalence and incidence of age-related macular degeneration, diabetic retinopathy and glaucoma are reported, providing an up-to-date and comprehensive overview of these diseases in Europe from an epidemiological perspective.
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Affiliation(s)
- Elena Prokofyeva
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany.
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Holtzer-Goor KM, van Sprundel E, Lemij HG, Plochg T, Klazinga NS, Koopmanschap MA. Cost-effectiveness of monitoring glaucoma patients in shared care: an economic evaluation alongside a randomized controlled trial. BMC Health Serv Res 2010; 10:312. [PMID: 21083880 PMCID: PMC3006381 DOI: 10.1186/1472-6963-10-312] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 11/17/2010] [Indexed: 11/21/2022] Open
Abstract
Background Population aging increases the number of glaucoma patients which leads to higher workloads of glaucoma specialists. If stable glaucoma patients were monitored by optometrists and ophthalmic technicians in a glaucoma follow-up unit (GFU) rather than by glaucoma specialists, the specialists' workload and waiting lists might be reduced. We compared costs and quality of care at the GFU with those of usual care by glaucoma specialists in the Rotterdam Eye Hospital (REH) in a 30-month randomized clinical trial. Because quality of care turned out to be similar, we focus here on the costs. Methods Stable glaucoma patients were randomized between the GFU and the glaucoma specialist group. Costs per patient year were calculated from four perspectives: those of patients, the Rotterdam Eye Hospital (REH), Dutch healthcare system, and society. The outcome measures were: compliance to the protocol; patient satisfaction; stability according to the practitioner; mean difference in IOP; results of the examinations; and number of treatment changes. Results Baseline characteristics (such as age, intraocular pressure and target pressure) were comparable between the GFU group (n = 410) and the glaucoma specialist group (n = 405). Despite a higher number of visits per year, mean hospital costs per patient year were lower in the GFU group (€139 vs. €161). Patients' time and travel costs were similar. Healthcare costs were significantly lower for the GFU group (€230 vs. €251), as were societal costs (€310 vs. €339) (p < 0.01). Bootstrap-, sensitivity- and scenario-analyses showed that the costs were robust when varying hospital policy and the duration of visits and tests. Conclusion We conclude that this GFU is cost-effective and deserves to be considered for implementation in other hospitals.
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Affiliation(s)
- Kim M Holtzer-Goor
- Institute for Medical Technology Assessment-Erasmus University Rotterdam, Rotterdam, the Netherlands.
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Syam P, Rughani K, Vardy SJ, Rimmer T, Fitt A, Husain T, McInerney L, Broome D, Driver R, Wormald R, Ramirez-Florez S. The Peterborough scheme for community specialist optometrists in glaucoma: a feasibility study. Eye (Lond) 2010; 24:1156-64. [PMID: 20186167 DOI: 10.1038/eye.2009.327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study assessed the role of specialist optometrists who were working in the community and sharing the care for glaucoma patients with, and under close supervision of, a consultant ophthalmologist working in the Hospital Eye Services (HES) to ensure high-quality standards, safety, and care. METHODS From February 2005 onwards, the majority of all new glaucoma referrals to our eye department were diverted to our specialist optometrists in glaucoma (SOGs) in their own community practices. Selected patients in the HES setting who were already diagnosed with stable glaucoma were also transferred to the SOGs. The completed clinical finding details of the SOGs, including fundus photographs and Humphrey visual field tests, were scrutinised by the project lead. RESULTS This study included 1184 new patients seen by specialist optometrists between February 2005 and March 2007. A total of 32% of patients were referred on to the hospital, leaving the remaining 68% patients to be seen for at least their next consultation in the community by the SOGs. The following levels of disagreement were observed between SOGs and the project lead: on cup:disc ratio (11%), visual field interpretation (7%), diagnosis (12%), treatment plan (10%), and outcome (follow-up interval and location) (17%). CONCLUSION This study indicates that there is potential for a significant increase in the role of primary care optometry in glaucoma management. The study also confirms a need for a significant element of supervision and advice from a glaucoma specialist. The important issue of cost effectiveness is yet to be confirmed.
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Affiliation(s)
- P Syam
- Eye Department, Peterborough & Stamford NHS Foundation Trust, Peterborough, UK
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Abstract
AIM To investigate the costs to patients attending hospital-based glaucoma clinics. METHODS A patient-based costs questionnaire was developed and completed for patients attending six ophthalmology units across London (Ealing General Hospital, St Georges Hospital, Mile End Hospital, Upney Centre Barking, St Ann's Hospital and the Royal London Hospital). The questionnaire considered age, sex, ethnicity as well as patient-based costs, opportunity costs, and companion costs. All patients visiting for review or appointments were approached non-selectively. A total of 100 patients were sampled from each unit. RESULTS The mean age of the full sample was 69.6 years (SD 12.6), with little variation between sites (68.5-71.8 years). There was an almost equal sex distribution (male (298 (50.6%)). There was no major difference in occupational distribution between sites. The majority of people came to hospital by bus (40%) or car (26%). Female patients went slightly more by cab or car, whereas male patients went slightly more by foot or train. There was some variability in transport method by site. The data showed that the Royal London hospital had the highest mean cost per visit (pound16.20), whereas St Georges had the lowest (pound12.90). Upney had the second highest mean cost per visit (pound15.20), whereas Ealing and St Ann's had similar mean costs of (pound13.25) and (pound13), respectively. Travel costs accounted for about one-fifth of the total patient's costs. For all glaucoma clinics, total societal costs were higher than the sum of patients' costs because of the high frequency of companions. A surprising finding was that two-thirds of the population (392 or 66.6%) reported no qualification-considerably higher than the national census statistics for the same population. CONCLUSIONS To our knowledge this paper presents direct and indirect patient costs in attending hospital glaucoma units for the first time. It highlights the significance of opportunity costs when considering health-care interventions as they amount to a third or more of the total costs of patient attendances to clinics.
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Rathod D, Win T, Pickering S, Austin M. Incorporation of avirtualassessment into a care pathway for initial glaucoma management: feasibility study. Clin Exp Ophthalmol 2008; 36:543-6. [DOI: 10.1111/j.1442-9071.2008.01831.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Azuara-Blanco A, Burr J, Thomas R, Maclennan G, McPherson S. The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendation for glaucoma. Br J Ophthalmol 2007; 91:1639-43. [PMID: 17537783 PMCID: PMC2095552 DOI: 10.1136/bjo.2007.119628] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2007] [Indexed: 11/04/2022]
Abstract
AIM To compare the diagnostic performance of accredited glaucoma optometrists (AGO) for both the diagnosis of glaucoma and the decision to treat with that of routine hospital eye care, against a reference standard of expert opinion (a consultant ophthalmologist with a special interest in glaucoma). METHODS A directly comparative, masked, performance study was undertaken in Grampian, Scotland. Of 165 people invited to participate, 100 (61%) were examined. People suspected of having glaucoma underwent, within one month, a full ophthalmic assessment in both a newly established community optometry led glaucoma management scheme and a consultant led hospital eye service. RESULTS Agreement between the AGO and the consultant ophthalmologist in diagnosing glaucoma was substantial (89%; kappa = 0.703, SE = 0.083). Agreement over the need for treatment was also substantial (88%; kappa = 0.716, SE = 0.076). The agreement between the trainee ophthalmologists and the consultant ophthalmologist in the diagnosis of glaucoma and treatment recommendation was moderate (83%, kappa = 0.541, SE = 0.098, SE = 0.98; and 81%, kappa = 0.553, SE = 0.90, respectively). The diagnostic accuracy of the optometrists in detecting glaucoma in this population was high for specificity (0.93 (95% confidence interval, 0.85 to 0.97)) but lower for sensitivity (0.76 (0.57 to 0.89)). Performance was similar when accuracy was assessed for treatment recommendation (sensitivity 0.73 (0.57 to 0.85); specificity 0.96 (0.88 to 0.99)). The differences in sensitivity and specificity between AGO and junior ophthalmologist were not statistically significant. CONCLUSIONS Community optometrists trained in glaucoma provided satisfactory decisions regarding diagnosis and initiation of treatment for glaucoma. With such additional training in glaucoma, optometrists are at least as accurate as junior ophthalmologists but some cases of glaucoma are missed.
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Affiliation(s)
- A Azuara-Blanco
- The Eye Clinic, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK.
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The influence of the new general ophthalmic services (GOS) contract in optometrist referrals for glaucoma in Scotland. Eye (Lond) 2007; 23:351-5. [DOI: 10.1038/sj.eye.6703045] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Lee PP, Kelly SP, Mills RP, Traverso CE, Walt JG, Doyle JJ, Katz LM, Siegartel LR. Glaucoma in the United States and europe: predicting costs and surgical rates based upon stage of disease. J Glaucoma 2007; 16:471-8. [PMID: 17700290 DOI: 10.1097/ijg.0b013e3180575202] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Primary open-angle glaucoma is a significant health-economic burden in both the United States and Europe that is likely to increase. This study compared treatment patterns and cost among patients with primary open-angle glaucoma in these locations. METHODS Retrospective medical chart reviews were conducted in the United States (1990 to 2002) and Europe (1995 to 2003). A total sample of 151 US charts and 194 European charts was studied, and patients were assigned a baseline intraocular pressure (IOP) and baseline stage, using a 6-stage visual functional glaucoma staging algorithm. Resource utilization and direct costs were assessed by stage of disease using publicly available United States and European costs. Cox Proportional Hazards modeling were used to examine covariates predicting glaucoma surgery. Total cost was predicted, adjusting for covariates using Generalized Linear Models, with baseline stage as the independent variable. RESULTS Glaucoma surgery requirement was highly associated with baseline disease stage and IOP increase before surgery in the United States and somewhat associated with these factors in Europe. Within both locations, baseline IOP was highly associated with glaucoma surgery requirement. Controlling for covariates, patients at higher baseline stages incurred greater costs in the United States (P=0.0017) and Europe (P=0.0715). Surgery and medication were also highly predictive of increased cost (P<0.0001). Cost of care differed greatly between the European countries, with costs lowest in Italy. CONCLUSIONS Increases in annual cost were related to higher baseline IOP, higher baseline stage, medication, and surgery. Thus, significant potential savings and reductions in annual healthcare burden are possible if patients are diagnosed and treated at earlier stages of glaucoma.
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