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Yunqi K, Kelvin LZ, Lian YS, Min QH, Sheryl TH, Min MC, Fang TY, Wai KL, Hau CC, Cherng Hui YV, Yong Khet Yau V, Tym WH. Impact of Community Eye Clinics (CEC) on Specialist Eye Clinic Referrals. Ophthalmic Epidemiol 2024; 31:315-320. [PMID: 37817451 DOI: 10.1080/09286586.2023.2261528] [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: 09/09/2022] [Accepted: 09/15/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Community Eye Clinics (CEC) increase accessibility of specialist ophthalmic services in the community, reducing demand for tertiary eye services. This paper aims to evaluate the impact of CEC on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC). METHODS A retrospective analysis was performed on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC) over a similar 3-months period before and after the introduction of CEC in August 2018 (1 January to 31 March in 2018 and 2019, respectively). Data pertaining to patients' presenting complaints, referral reasons, final diagnoses, follow-up plans, and need for ophthalmic intervention were obtained. RESULTS We included 978 patients in our study. There was a 27.5% reduction in the number of first-visit referrals seen at SOC after the establishment of CEC. Patients were more likely to be referred on to sub-specialty eye clinics (10.8% vs. 12.9%, p= p = .304) and receive more ophthalmic interventions (15% vs. 16.3%, p = .066) than prior to CEC. CONCLUSION The CEC provides greater accessibility to eye care within the community. Optometrists are upskilled to manage patients with stable eye conditions, whilst eye specialists can provide timely care to the SOC for patients with more severe eye conditions.
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Affiliation(s)
- Koh Yunqi
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
| | - Li Zhenghao Kelvin
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
| | - Yau Siew Lian
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
| | | | | | | | | | | | | | - Yip Vivien Cherng Hui
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
| | - Vernon Yong Khet Yau
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
- Lee Kong Chian School of Medicine, National Technological University, Singapore, Singapore
| | - Wong Hon Tym
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
- Centre for Healthcare Innovation, Singapore, Singapore
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Chan SCY, Shah PR, Tan K, Ford B, Webber A, Keay L. Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study. Ophthalmic Physiol Opt 2023; 43:997-1006. [PMID: 37150970 DOI: 10.1111/opo.13160] [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: 01/02/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks. METHODS Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care. RESULTS One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders. CONCLUSIONS This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.
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Affiliation(s)
- Stephen C Y Chan
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Parth R Shah
- Department of Paediatric Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kimberley Tan
- Department of Paediatric Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Belinda Ford
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ann Webber
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry & Vision Science, Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Foster M, Weaver J, Shalaby R, Eboreime E, Poong K, Gusnowski A, Snaterse M, Surood S, Urichuk L, Agyapong VIO. Shared Care Practices in Community Addiction and Mental Health Services: A Qualitative Study on the Experiences and Perspectives of Stakeholders. Healthcare (Basel) 2022; 10:healthcare10050831. [PMID: 35627967 PMCID: PMC9140640 DOI: 10.3390/healthcare10050831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 12/04/2022] Open
Abstract
Shared care involves collaboration between primary care, secondary and tertiary care that enables the allocation of responsibilities of care according to the treatment needs of patients over the course of a mental illness. This study aims to determine stakeholders’ perspectives on the features of an ideal shared care model and barriers to practicing shared care within addiction and mental health programs in Edmonton, Canada. This is a qualitative cross-sectional study with data collected through focus group discussions. Participants included patients, general practitioners, psychiatrists, management, and therapists working in primary and secondary addiction and mental health. Responses were audio-recorded, transcribed, and analyzed thematically. Perceived barriers to the implementation of an ideal shared care model identified by participants include fragmented communication between primary and secondary healthcare providers, patient and family physician discomfort with discussing addiction and mental health, a lack of staff capacity, confidentiality issues, and practitioner buy-in. Participants also identified enablers to include implementing shared electronic medical record systems, improving communication and collaboration, physical co-location, and increasing practitioner awareness of appropriate referrals and services. This original research provides stakeholders’ perspectives on the features of an ideal shared care model and barriers to practicing shared care within addiction and mental health programs.
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Affiliation(s)
- Michele Foster
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Julia Weaver
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Kimberly Poong
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - April Gusnowski
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Mark Snaterse
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Shireen Surood
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Liana Urichuk
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence: ; Tel.: +1-780-215-7771; Fax: +1-902-473-4887
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