Improving care and increasing efficiency—challenges in the care of chronic eye diseases

Kotecha, Aachal; Turner, Simon; Vasilakis, Christos; Utley, Martin; Fulop, Naomi; Azuara‐Blanco, Augusto; Foster, Paul J.

doi:10.1038/eye.2014.135

Cited by 19 publications

(10 citation statements)

References 35 publications

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“… 21 , 22 Thus, some are starting to believe that removal of the face-to-face doctor consultation and remotely reviewing ophthalmic data may be a more efficient way to manage some patients within the NHS clinic. 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting

Kotecha¹,

Baldwin²,

Brookes³

et al. 2015

OPTH

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BackgroundThis article describes the development of a virtual glaucoma clinic, whereby technicians collect information for remote review by a consultant specialist.Design and MethodsThis was a hospital-based service evaluation study. Patients suitable for the stable monitoring service (SMS) were low-risk patients with “suspect”, “early”-to-“moderate” glaucoma who were deemed stable by their consultant care team. Three technicians and one health care assistant ran the service. Patients underwent tests in a streamlined manner in a dedicated clinical facility, with virtual review of data by a consultant specialist through an electronic patient record.Main outcome measureFeasibility of developing a novel service within a UK National Health Service setting and improvement of patient journey time within the service were studied.ResultsChallenges to implementation of virtual clinic include staffing issues and use of information technology. Patient journey time within the SMS averaged 51 minutes, compared with 92 minutes in the glaucoma outpatient department. Patient satisfaction with the new service was high.ConclusionImplementing innovation into existing services of the National Health Service is challenging. However, the virtual clinic showed an improved patient journey time compared with that experienced within the general glaucoma outpatient department. There exists a discrepancy between patient management decisions of reviewers, suggesting that some may be more risk averse than others when managing patients seen within this model. Future work will assess the ability to detect progression of disease in this model compared with the general outpatient model of care.

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Section: Introductionmentioning

confidence: 99%

Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting

Kotecha¹,

Baldwin²,

Brookes³

et al. 2015

OPTH

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show abstract

“…The increase in life expectancy in the UK, together with increasing referral of early cases and suspects has seen 7–8% per year growth in demand for glaucoma service appointments at Moorfields Eye Hospital. 4 National Institute for Health and Care Excellence (NICE) guidelines for the diagnosis and management of chronic open-angle glaucoma and ocular hypertension in 2009 (NICE, 2009) led to significant increases in referral numbers across the NHS. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Measures of socioeconomic status and self-reported glaucoma in the UK Biobank cohort

Shweikh

Chan

et al. 2015

Eye

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PurposeTo determine ocular, demographic, and socioeconomic associations with self-reported glaucoma in the UK Biobank.MethodsBiobank is a study of UK residents aged 40–69 years registered with the National Health Service. Data were collected on visual acuity, intraocular pressure (IOP), corneal biomechanics, and questionnaire from 112 690 participants. Relationships between ocular, demographic, and socioeconomic variables with reported diagnosis of glaucoma were examined.ResultsIn all, 1916 (1.7%) people in UK Biobank reported glaucoma diagnosis. Participants reporting glaucoma were more likely to be older (mean 61.4 vs 56.7 years, P<0.001) and male (2.1% vs 1.4%, P=0.001). The rate of reported glaucoma was significantly higher in Black (3.28%, P<0.001) and Asian (2.14%, P=0.009) participants compared with White participants (1.62%, reference). Cases of reported glaucoma had a higher mean IOP (18 mm Hg both eyes, P<0.001), lower corneal hysteresis (9.96 right eye, 9.89 left eye, P<0.001), and lower visual acuity (0.09 logMAR right eye, 0.08 logMAR left eye, P<0.001) compared with those without (16 mm Hg both eyes, hysteresis 10.67 right eye, 10.63 left eye, 0.03 logMAR right eye, 0.02 logMAR left eye). The mean Townsend deprivation index was −0.72 for those reporting glaucoma and −0.95 for those without (P<0.001), indicating greater relative deprivation in those reporting glaucoma. Multivariable logistic regression showed that people in the lowest income group (<£18 000/year) were significantly more likely to report a diagnosis of glaucoma compared with any other income level (P<0.01). We observed increasing glaucoma risk across the full range of income categories, with highest risk among those of lowest income, and no evidence of a threshold effect.ConclusionsIn a large UK cohort, individuals reporting glaucoma had more adverse socioeconomic characteristics. Study of the mechanisms explaining these effects may aid our understanding of health inequality and will help inform public health interventions.

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“…With the ageing of the population and the increasing prevalence of chronic diseases worldwide, the demand for health services such as ophthalmology services has been escalating. In England, hospital outpatient services for ophthalmology ranked second after trauma and orthopaedics, accounting for 8.6 % of total outpatient activities [ 1 ]. In Malaysia, despite only a small increase in the proportion of elderly people in the population over the last decade (above 65 years old, 3.9 % to 5.1 % from 2000 to 2010) [ 2 ], its public hospitals have seen a two to four-fold rise in ophthalmology outpatient visits, inpatient admissions and surgeries [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia

Foo

Lim

Sivasampu

et al. 2015

BMC Health Serv Res

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BackgroundRising demand of ophthalmology care is increasingly straining Malaysia’s public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance.MethodsData for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis (DEA). Efficiency scores (ES) were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores.ResultsIn 2011, 33 % of the ophthalmology centres were found to have ES > 1 (mean ES = 1.10). Potential output gains were 10 % (SE ± 2.92), 7.4 % (SE ± 2.06), 6.9 % (SE ± 1.97) if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 (mean ES = 1.07), with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance.ConclusionsUsing DEA to benchmarking service performance of ophthalmology care could provide insights for policy makers and service managers to intuitively visualise the overall performance of resource use in an otherwise difficult to assess scenario. The considerable potential output gain estimated indicates that effort should be invested to understand what drove the performance variation and optimise them. Similar performance assessment should be undertaken for other healthcare services in the country in order to work towards a sustainable health system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1011-0) contains supplementary material, which is available to authorized users.

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Improving care and increasing efficiency—challenges in the care of chronic eye diseases

Cited by 19 publications

References 35 publications

Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting

Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting

Measures of socioeconomic status and self-reported glaucoma in the UK Biobank cohort

Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia

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