Improving Patient Access and Reducing Costs for Glaucoma with Integrated Hospital and Community Care: A Case Study from Australia

Ford, Belinda; Angell, Blake; Liew, Gerald; White, Andrew; Keay, Lisa

doi:10.5334/ijic.4642

Cited by 24 publications

(28 citation statements)

References 20 publications

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“…This study also documented the long waiting times, in excess of a year for a hospital appointment and that one‐in‐six patients did not have glaucoma or were discharged from the hospital clinic. This confirms a role for schemes to triage2019 these referrals or referral refinement 2010…”

Section: Discussionmentioning

confidence: 61%

Glaucoma referrals from primary care and subsequent hospital management in an urban Australian hospital

Ford

Kim

Keay

et al. 2020

Clinical and Experimental Optometry

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Background: Public hospital ophthalmology services are in high demand and patients requiring medical or surgical intervention for glaucoma may worsen while awaiting care. In Australia, tertiary hospital care requires a referral from primary care providers. This study investigates the quality of glaucoma referrals received at a tertiary public hospital in Australia, and describes the types of glaucoma cases referred for hospital management. Methods: An investigation of 200 sequential glaucoma referrals received at a major Australian public hospital from 2013-2016, and the subsequent hospital management. A clinical file audit was made of patient medical records, including referral letters to extract the referral content, and the hospital glaucoma diagnostic outcomes and patient management. Results: Most referrals came from optometrists (72 per cent) and general practitioners (22 per cent) with the remainder from other specialists. The majority of the referrals contained less than 50 per cent of the key clinical and demographic parameters. Referrals from optometrists provided more ophthalmic information (visual acuity, visual field, intraocular pressure, ocular history). Referrals from general practitioners contained more medical information (systemic co-morbidities medication and allergies). The median wait-time from referral to hospital appointment was 400 days. Of patients attending a hospital appointment, 59 per cent required surgical or medical management, and 16 per cent did not have glaucoma. Overall 18 per cent were discharged, with no differences noted by referral content or referring practitioner. Conclusion: Most referrals did not include useful diagnostic information on ocular, medical and social risks for glaucoma. There is an opportunity to improve targeting of primary care referrals for glaucoma, since patients who were discharged immediately after their hospital appointment are exacerbating the long hospital wait-time. Better information transfer may help to identify patients requiring more urgent intervention. A standardised referral template and guidelines would support collaborative care and streamline access to hospital services.

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Section: Discussionmentioning

confidence: 61%

Glaucoma referrals from primary care and subsequent hospital management in an urban Australian hospital

Ford

Kim

Keay

et al. 2020

Clinical and Experimental Optometry

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“…Several investigations have quantified the clinical examination, test interpretation and the clinical decision-making of optometrists versus ophthalmologists in glaucoma care. 22 – 27 Substantial agreement between ophthalmologists and optometrists on management decisions has been demonstrated in many of these, 22 – 27 with higher levels of training being linked with higher agreement between care providers. 25 The results from this scheme align with these findings of good agreement between the optometrists’ clinical examination findings and decisions to return patients non-routinely to the hospital, and the ophthalmologists’ decisions when these patients were seen.…”

Section: Discussionmentioning

confidence: 99%

Results of a Glaucoma Shared Care Model Using the Enhanced Glaucoma Staging System and Disc Damage Likelihood Scale with a Novel Scoring Scheme in New Zealand

Buller¹

2021

OPTH

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“…There have been a number of studies reporting the benefits of using telemedicine or collaborative care to screen populations for DR, 13 14 and a more recent study has demonstrated that collaborative care models can be used in the Australian setting to assist hospitals to improve efficiencies and reduce costs for existing referral wait lists for low-risk glaucoma. 15 However, there have been relatively few reports to quantify ways in which such collaborative care models would perform for DR.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia

et al. 2020

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ObjectivesTo determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use resources, compared with hospital-based care.DesignRetrospective audit of medical and financial records to compare two models of care.SettingA large, urban tertiary Australian publicly funded hospital.InterventionC-EYE-C is a collaborative care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. The C-EYE-C model of care was implemented from January to October 2017.ParticipantsNew low-risk patient referrals with diabetes received at a tertiary hospital ophthalmology unit.Primary and secondary outcomesHistorical standard hospital care was compared with C-EYE-C for attendance, wait-times, outcomes and costs. Clinical concordance between the optometrist and ophthalmologist diagnosis and management was assessed using weighted kappa statistic.ResultsThere were 133 new low-risk referrals, managed in standard hospital care (n=68) and C-EYE-C (n=65). Attendance rates were similar between the models of care (72.1% hospital vs 67.7% C-EYE-C, p=0.71). C-EYE-C had shorter appointment wait-time (53 vs 118 days, p<0.01). In the C-EYE-C model of care, 68.2% of patients did not require hospital appointments and costs were 43% less than hospital care. There was substantial agreement between optometrists and ophthalmologists for diagnosis (κ=0.64, CI 0.47–0.81) and management (κ=0.66, CI 0.45–0.87).ConclusionThis Australian study showed that collaborative eye care resulted in reduced patient waiting times and considerable cost-savings, while maintaining a high standard of patient care compared with traditional hospital-based care in the management of low-risk hospital referrals with diabetic eye disease. The improved access and reduced costs were largely the result of better task allocation through greater utilisation of primary eye care professionals to provide services for low-risk patients. Better resource use may free up further resources for other eye care services.

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Improving Patient Access and Reducing Costs for Glaucoma with Integrated Hospital and Community Care: A Case Study from Australia

Cited by 24 publications

References 20 publications

Glaucoma referrals from primary care and subsequent hospital management in an urban Australian hospital

Glaucoma referrals from primary care and subsequent hospital management in an urban Australian hospital

Results of a Glaucoma Shared Care Model Using the Enhanced Glaucoma Staging System and Disc Damage Likelihood Scale with a Novel Scoring Scheme in New Zealand

Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia

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