Introduction:Glaucoma, a chronic eye disease requires regular monitoring and treatment to prevent vision-loss. In Australia, most public ophthalmology departments are overburdened. Community Eye Care is a ‘collaborative’ care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. C-EYE-C was implemented at one Australian hospital. This study aims to determine whether C-EYE-C improves access to care and better utilises resources, compared to hospital-based care.Methods:A clinical and financial audit was conducted to compare access to care and health system costs for hospital care and C-EYE-C. Attendance, wait-time, patient outcomes, and the average cost per encounter were calculated. A weighted kappa assessed agreement between the optometrist and ophthalmologist decisions.Results:There were 503 low-risk referrals, hospital (n = 182) and C-EYE-C (n = 321). C-EYE-C had higher attendance (81.6% vs 68.7%, p = 0.001); and shorter appointment wait-time (89 vs 386 days, p < 0.001). Following C-EYE-C, 57% of patients avoided hospital; with 39% requiring glaucoma management. C-EYE-C costs were 22% less than hospital care. There was substantial agreement between optometrists and ophthalmologist for diagnosis (k = 0.69, CI 0.61–0.76) and management (k = 0.66, CI 0.57–0.74).Discussion:C-EYE-C showed higher attendance, and reduced wait-times and health system costs.Conclusions:Upscale of the C-EYE-C model should be considered to further improve capacity of public eye services in Australia.

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.

ImportancePatient perspectives are crucial in informing design of acceptable services.BackgroundThis study determined patient preferences in glaucoma care.DesignA discrete choice experiment was used to evaluate the relative importance of out‐of‐pocket costs, waiting time, continuity of care, service location and expertise.ParticipantsNinety‐eight glaucoma suspects or glaucoma patients were recruited from one public and two private clinics in Sydney.MethodsTwelve choice‐tasks were presented in random order and forced‐choice preferences were elicited. Choice data were analysed using a multinominal logit model (NLOGIT 4.0).Main Outcome MeasuresThe relative importance and the likelihood of choosing services with each attribute were determined. Willingness‐to‐pay and willingness‐to‐wait were calculated. Analyses were stratified by whether the patient attended a public or private glaucoma clinic and other demographic features.ResultsChoice was influenced by four or five attributes: greater clinician expertise, the same clinician each visit, lower out‐of‐pocket costs and shorter wait times (all P < .05). Respondents were willing to pay an additional (Australian dollars) $325 (95% confidence interval [CI] 188‐389) to see a senior eye doctor, and $87 (95% CI 60‐116) to see the same clinician each visit. Respondents were willing to wait for these attributes; however, the estimates had wide confidence intervals and were beyond the range tested. Private patients had a stronger preference for expertise and continuity of care compared to public patients.Conclusions and RelevanceExpertise and continuity of care were important to glaucoma patients in this setting, and they were willing to pay out‐of‐pocket and concede longer waiting times to secure these preferences.