Shared Care in Monitoring Stable Glaucoma Patients

Abstract

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.

Glaucoma Community Care: Does Ongoing Shared Care Work?

“…The importance of additional training in areas of interest has been emphasised previously in Ireland and Canada [28,29]. Allocation decisions were driven by factors described in the peer-reviewed literature including: loss of visual acuity, intraocular pressure exceeding target, signs suspicious of structural or functional progression (such as a new disc haemorrhage, retinal nerve fibre layer defect, change in the disc rim), and/or intolerance to treatment [1,6,11]. Patients initiated on therapy and subsequently reviewed 6-8 weeks later for a short subsequent consultation might have extra tests performed and interpreted at the discretion of the examining optometrist e.g.…”

“…Other enabling factors included the face-to-face co-delivery of protocol-based care in a neutral, community based clinical setting, without any on-site spectacle or other device sales, as well as access to ophthalmology supervision and expertise either in person or remotely at any time. This final point on the value of virtual clinical oversight has been emphasised previously [1,32]. It increases outpatient capacity, referral rates, and overall patient satisfaction [33,34] and might in the future evolve into a virtual process applying big data for a more robust evaluation of patient outcomes [35].…”

“…Suitably trained optometrists have also shown good adherence to guidelines regarding initial treatment decisions and the timing of regular monitoring [8,18]. Yet, there is a paucity of data on successful glaucoma shared care schemes outside of the United Kingdom [1].…”

“…Glaucoma is a progressive optic neuropathy and a leading cause of vision impairment worldwide that requires life-long surveillance and management [ 1 ]. Health care professionals, including optometrists, are typically involved in case finding and refer to specialists (ophthalmologists) for treatment.…”

“…In Australia, there are only 990 qualified ophthalmologists to meet the demand and only 16 per cent are employed in the public sector [ 4 ]. These ophthalmology workforce numbers are not expected to grow in line with the expansion of the aged population [ 5 ], which has thus led to a growing global interest in glaucoma shared care models [ 1 6 7 8 9 10 11 12 13 ].…”