Therapeutic endorsement enhances compliance with national glaucoma guidelines in Australian and New Zealand optometrists

Zangerl, Barbara; Hayen, Andrew; Mitchell, Paul; Jamous, Khalid F; Stapleton, Fiona; Kalloniatis, Michael

doi:10.1111/opo.12197

Cited by 12 publications

(33 citation statements)

References 59 publications

(76 reference statements)

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“…Modifiable factors that have been shown to impact appropriateness of eye care delivery include data entry system (i.e. electronic or paper records) [134], health insurance coverage [76], higher eye care provider density [76], awareness of clinical practice guidelines availability [142], procedural confidence and therapeutic endorsement of optometrists [56] and specialty training conducted in a supportive environment [43]. Non-modifiable factors that may impact appropriateness of eye care include the severity of patients’ eye condition [71], patient’s age and ethnicity [54], and practitioner’s age [72, 129], gender [129] and years of experience [88].…”

Section: Resultsmentioning

confidence: 99%

Systematic review of the appropriateness of eye care delivery in eye care practice

Stapleton

Wiles

et al. 2019

BMC Health Serv Res

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Background Health care systems are continually being reformed, however care improvement and intervention effectiveness are often assumed, not measured. This paper aimed to review findings from published studies about the appropriateness of eye care delivery, using existing published evidence and/or experts’ practice and to describe the methods used to measure appropriateness of eye care. Methods A systematic search was conducted using Medline, Embase and CINAHL (2006 to September 2016). Studies reporting the processes of eye care delivery against existing published evidence and/or experts’ practice were selected. Data was extracted from published reports and the methodological quality using a modified critical appraisal tool. The primary outcomes were percentage of appropriateness of eye care delivery. This study was registered with PROSPERO, reference CRD42016049974. Results Fifty-seven studies were included. Most studies assessed glaucoma and diabetic retinopathy and the overall methodological quality for most studies was moderate. The ranges of appropriateness of care delivery were 2–100% for glaucoma, 0–100% for diabetic retinopathy and 0–100% for other miscellaneous conditions. Published studies assessed a single ocular condition, a sample from a single centre or a single domain of care, but no study has attempted to measure the overall appropriateness of eye care delivery. Conclusions These findings indicated a wide range of appropriateness of eye care delivery, for glaucoma and diabetic eye care. Future research would benefit from a comprehensive approach where appropriateness of eye care is measured across multiple conditions with a single methodology, to guide priorities within eye care delivery and monitor quality improvement initiatives. Electronic supplementary material The online version of this article (10.1186/s12913-019-4493-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Systematic review of the appropriateness of eye care delivery in eye care practice

Stapleton

Wiles

et al. 2019

BMC Health Serv Res

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“…[34][35][36] The ability of a practitioner to monitor glaucoma suspects in their own community practice may be affected by knowledge of best practice guidelines, procedural confidence in conducting comprehensive glaucoma assessments and therapeutic endorsement. 37 Remuneration may also have a significant impact; the introduction of higher remuneration for additional testing of glaucoma suspects in the community resulted in fewer false positive referrals to hospital eye clinics in Scotland. 38 In Australia, optometry consultation fees are subsidised by Medicare, the national health-care scheme.…”

Section: False Positive Rate Of Optometrist-initiated Glaucoma Referralsmentioning

confidence: 99%

Impact of referral refinement on management of glaucoma suspects in Australia

Huang

Yapp

Hennessy

et al. 2020

Clinical and Experimental Optometry

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Background In ageing populations, the prevalence of chronic diseases such as glaucoma is projected to increase, placing additional demands on limited health‐care resources. In the UK, the demand for secondary care in hospital eye clinics was inflated by high rates of false positive glaucoma referrals. Collaborative care models incorporating referral refinement, whereby glaucoma suspect referrals are triaged by suitably trained optometrists through further testing, can potentially reduce false positive referrals. This study examined the impact of a referral refinement model on the accuracy of glaucoma referrals in Australia. Methods Optometrist‐initiated glaucoma suspect referrals to the Glaucoma Management Clinic (Sydney, Australia) were prospectively recruited. Glaucoma suspect referrals arising from two pathways were eligible for inclusion, either directly from a community optometrist (standard care) or following comprehensive assessment at the Centre for Eye Health (referral refinement). Main outcome measures were the positive predictive value and false positive rate of referrals. The impact of referral letter content on management outcomes was also investigated. Results Of 464 referrals received between March 2015 and June 2018, 252 were for treatment of naïve glaucoma suspects and eligible for inclusion. Following ophthalmological assessment, 45.6 per cent (n = 115/252) were prescribed treatment for open angle glaucoma or ocular hypertension. Positive predictive value of community optometry referrals was 33.8 per cent (n = 25/74) and 50.6 per cent (n = 90/178) following referral refinement. The first visit discharge (false positive) rate was 26 per cent (n = 19/74) for community referrals compared to four per cent (n = 8/178) with referral refinement. Positive predictive value increased with the number of abnormal clinical examination findings associated with referral (χ2 test, p < 0.0001). The number of abnormal findings reported in referrals was significantly higher with referral refinement compared to without (n = 1.9 versus 1.5, t‐test, p < 0.0001). Conclusion Referral refinement can improve the diagnostic accuracy of optometry‐initiated referrals for glaucoma suspects in Australia, thereby decreasing unnecessary referrals to hospital and other secondary clinics.

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“…The differentiation of optic neuropathies, particularly in the face of combined aetiologies and individual variations in the ganglion cell/nerve fibre layer complex, remains a clinical challenge. Systematic and comprehensive evaluation of clinical information enhances diagnostic acumen, as long as the clinician can differentiate useful from not‐so‐useful clinical information . Therefore, adding to long standing criteria, we have developed an expanded and improved clinical reference (Figure ) to aid in the differential diagnosis of optic neuropathies.…”

Section: Resultsmentioning

confidence: 99%

Reconciling visual field defects and retinal nerve fibre layer asymmetric patterns in retrograde degeneration: an extended case series

Zangerl

Whatham

Kim

et al. 2017

Clinical and Experimental Optometry

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BackgroundAccurate diagnosis in patients presenting with lesions at various locations within the visual pathway is challenging. This study investigated functional and structural changes secondary to such lesions to identify patterns useful to guide early and effective management.MethodsOver 10,000 records from patients referred for optic nerve head assessment were reviewed and 31 patients with a final diagnosis of likely neuropathic lesions posterior to the eye were included in the current study. Fundus photographs, optic coherence tomography images and visual field tests were evaluated for changes with respect to retinal nerve fibre layer topography and prediction of structure‐function paradigms. Emerging clinical patterns were examined for their consistency with the likely anatomical origin of the underlying insult in the presence of varying diagnoses.ResultsData from patients with lesions along the visual system allowed identification of retinal nerve fibre layer asymmetry correlated with visual field defects and ganglion cell analysis. Bilateral discordance in retinal nerve fibre loss easily discernible from an altered pattern of the temporal‐superior‐nasal‐inferior‐temporal curve was characteristic for post‐chiasmal lesions. These sometimes‐subtle changes supported diagnosis in cases with multiple aetiologies or with ambiguous visual field analysis and/or ganglion cell loss.ConclusionIntricate knowledge of the retinal architecture and projections allows coherent predictions of functional and structural deficits following various lesions affecting the visual pathway. The integration of adjunct imaging and retinal nerve fibre layer thinning will assist clinicians to guide clinical investigations toward a likely diagnosis in the light of significant individual variations. The case series presented in this study aids in differential diagnosis of retrograde optic neuropathies by using retinal nerve fibre layer asymmetric patterns as an important clinical marker.

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Therapeutic endorsement enhances compliance with national glaucoma guidelines in Australian and New Zealand optometrists

Cited by 12 publications

References 59 publications

Systematic review of the appropriateness of eye care delivery in eye care practice

Systematic review of the appropriateness of eye care delivery in eye care practice

Impact of referral refinement on management of glaucoma suspects in Australia

Reconciling visual field defects and retinal nerve fibre layer asymmetric patterns in retrograde degeneration: an extended case series

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