Australian optometric and ophthalmologic referral pathways for people with age‐related macular degeneration, diabetic retinopathy and glaucoma

Jamous, Khalid F; Jalbert, Isabelle; Kalloniatis, Michael; Boon, Mei Ying

doi:10.1111/cxo.12119

Cited by 13 publications

(18 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many optometrists and ophthalmologists commented on the lack of effective AMD care coordination in the current health system. Eyecare professionals' descriptions of a unidirectional, ineffective model of AMD care aligns with previous research findings [36][37][38]. Previous research has suggested that the role of the optometrist in the ophthalmic care pathway often goes unrecognised, with optometrists seen differently from other healthcare professionals [39].…”

Section: Models Of Care: a Role For Amd Case Managers?supporting

confidence: 77%

A qualitative exploration of Australian eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care

et al. 2020

Self Cite

View full text Add to dashboard Cite

Despite the existence of evidence-based recommendations to decrease risk and progression of Age-Related Macular Degeneration (AMD) for some time, self-reported practices suggest that eyecare professionals' advice and people with AMD's adherence to these recommendations can be very poor. This study uses qualitative methods to explore Australian eyecare professionals' perspective on barriers to effective AMD care. Seven focus groups involving 65 optometrists were conducted by an experienced facilitator. A nominal group technique was used to identify, prioritize and semi-quantify barriers and enablers to AMD care. Participants individually ranked their perceived top five barriers and enablers with the most important granted a score of 5 and the least important a score of 1. For each barrier or enabler, the number of votes it received and its total score were recorded. Barriers and enablers selected by at least one participant in their top 5 were then qualitatively analysed, grouped using thematic analysis and total score calculated for each consolidated barrier or enabler. In-depth individual interviews were conducted with 10 ophthalmologists and 2 optometrists. Contributions were audio-recorded, transcribed verbatim and analysed with NVivo software. One hundred and sixty-nine barriers and 51 enablers to AMD care were identified in the focus groups. Of these, 102 barriers and 42 enablers were selected as one of their top 5 by at least one participant and further consolidated into 16 barriers and 10 enablers after thematic analysis. Factors impacting AMD care identified through analysis of the transcripts were coded to three categories of influence: patient-centered, practitionercentered, and structural factors. Eyecare professionals considered poor care pathways, people with AMD's poor disease understanding / denial, and cost of care / lack of funding, as the most significant barriers to AMD care; they considered shared care model, access, and communication as the most significant enablers to good AMD care. These findings suggest that Australian eyecare professionals perceive that there is a need for improved patient support systems and appropriately funded, clearer care pathway to benefit people with AMD.

show abstract

Section: Models Of Care: a Role For Amd Case Managers?supporting

confidence: 77%

A qualitative exploration of Australian eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…In some cases, referral to other suitable services can address conditions with intermediate levels of urgency and accommodate patient readiness and their capacity to travel or pay costs associated with referral whilst also preventing unnecessary burden on ophthalmology. Finally, current two‐tiered eye‐care systems have been criticised as ‘fragmented’ and inefficient . Robust, efficient and targeted referral pathways that better utilise all of the eye‐care professions in order to optimise long‐term patient outcomes in macular disease need to be developed…”

Section: Introductionmentioning

confidence: 99%

Collaborative care of non‐urgent macular disease: a study of inter‐optometric referrals

Ly¹,

Nivison‐Smith²,

Hennessy

et al. 2016

Ophthalmic Physiologic Optic

Self Cite

View full text Add to dashboard Cite

PurposeDiseases involving the macula and posterior pole are leading causes of visual impairment and blindness worldwide and may require prompt ophthalmological care. However, access to eye‐care and timely patient management may be limited due to inefficient and inappropriate referrals between primary eye‐care providers and ophthalmology. Optometrists with a special interest in macular disease may be useful as a community aid to better stratify and recommend best‐practice management plans for suitable patients. This study assesses such a notion by appraising the optometric referral patterns of patients with suspected macular disease to an intermediate‐tier optometric imaging clinic.MethodsWe performed a retrospective review of patient records and referrals using patients examined at Centre for Eye Health (CFEH) for an initial or follow up macular assessment between the 1/7/2013 and 30/6/2014 (n = 291). The following data were analysed: patient demographic characteristics, primary reason for referral, diagnosed/suspected condition, CFEH diagnosis and recommended management plan.ResultsThe number of referrals stipulating a diagnosis, confirmed after evaluation at CFEH was 121 of 291 (42%). After evaluation at CFEH, the number of cases without a specific diagnosis was approximately halved (reduced from 47% to 23%), while the number of cases with no apparent defect or normal aging changes rose from 1% to 15%. Overall diagnostic congruency for specified macular conditions was high (58–94%); cases were seldom (30/291, 10%) found to have a completely different macular condition. 244 of 291 (84%) patients seen at CFEH were recommended ongoing optometric care: either with the referring optometrist or through recall to CFEH. Referral to an ophthalmologist was recommended in 47 instances (16%).ConclusionsMore widespread adoption of intermediate‐tier optometric eye‐care referral pathways in macular disease (following opportunistic primary care screening) has the potential to reduce the number of cases with non‐specific diagnoses and to increase those with a diagnosis of normal aging changes or no apparent disease. The majority of cases seen under this intermediate‐tier model required ongoing optometric care only and did not require face‐to‐face consultation with an ophthalmologist.

show abstract

“…The conventional referral pathway for patients with pigmented lesions in many eye‐care systems starts with an assessment in primary care, followed by referral to a general ophthalmologist, and then onto a retinal specialist or ocular oncologist as required. However, specialist care may be overburdened by false positive referrals of benign lesions, and inter‐optometric referrals are uncommon . Chronic and/or well controlled conditions may not require ophthalmological management .…”

Section: Introductionmentioning

confidence: 99%

The advantages of intermediate‐tier, inter‐optometric referral of low risk pigmented lesions

Nivison‐Smith

Hennessy

et al. 2017

Ophthalmic Physiologic Optic

Self Cite

View full text Add to dashboard Cite

Purpose: Pigmented ocular lesions are commonly encountered by eye-care professionals, and range from benign to sight or life-threatening. After identifying a lesion, the primary care professional must establish the likely diagnosis and decide either to reassure, to monitor or to refer. The increasing use of ocular imaging technologies has contributed to an increase in the detection rate of pigmented lesions and a higher number of referrals, which may challenge existing pathways of health-care delivery. Specialist services may be over-burdened by referring all patients with pigmented lesions for an opinion, while inter-optometric referrals are underutilised. The aim of this study was to describe the referral patterns of pigmented lesions to an optometry led intermediate-tier collaborative care clinic. Methods: We performed a retrospective review of patient records using the list of patients examined at Centre for Eye Health (CFEH) for an initial or follow up pigmented lesion assessment between the 1/7/2013 and the 30/6/2016. Analysis was performed on: patient demographic characteristics, the referrer's tentative diagnosis, CFEH diagnosis and recommended management plan. Results: Across 182 patient records, the primary lesion prompting referral was usually located in the posterior segment: choroidal naevus (105/182, 58%), congenital hypertrophy of the retinal pigment epithelium (CHRPE; 11/182, 6%), chorioretinal scarring (10/182, 5%) or not specified (52/182, 29%). Referrals described a specific request for ocular imaging in 25 instances (14%). The number of cases with a non-specific diagnosis was reduced after intermediate-tier care assessment (from 29% to 10%), while the number of diagnoses with less common conditions rose (from 2% to 21%). There was a 2% false positive referral rate to intermediatetier care and a first visit discharge rate of 35%. A minority required on-referral to an ophthalmologist (22/182, 12%), either for unrelated incidental ocular findings, or suspicious choroidal naevi. Conditions most amenable to optometric follow up included: 1) chorioretinal scarring, 2) choroidal naevus, and 3) CHRPE. Conclusions: Intermediate-tier optometric eye-care in pigmented lesions (following opportunistic primary care screening) has the potential to reduce the number of cases with non-specific diagnoses and to increase those with less common diagnoses. The majority of cases seen under this intermediate-tier model required only ongoing optometric surveillance.

show abstract

Australian optometric and ophthalmologic referral pathways for people with age‐related macular degeneration, diabetic retinopathy and glaucoma

Cited by 13 publications

References 38 publications

A qualitative exploration of Australian eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care

A qualitative exploration of Australian eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care

Collaborative care of non‐urgent macular disease: a study of inter‐optometric referrals

The advantages of intermediate‐tier, inter‐optometric referral of low risk pigmented lesions

Contact Info

Product

Resources

About