Analysis of a Physician-led, Team-based Care Model for the Treatment of Glaucoma

Winkler, Nelson S.; Damento, Gena M.; Khanna, Sunil S.; Hodge, David O.; Khanna, Cheryl L.

doi:10.1097/ijg.0000000000000689

Cited by 6 publications

(13 citation statements)

References 16 publications

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“…Winkler et al implemented such a protocol for glaucoma care at Mayo Clinic’s campus in Rochester, Minnesota reviewing records of 591 patients with newly diagnosed glaucoma for documentation of 9 POAG PPP elements in the three years before and after protocol implementation. [17] They found a significant increase in adherence to AAO recommendations in documentation of target IOP (+24%), gonioscopy (+27%), fundus photos (+29%), and OCT (+20%) after protocol initiation. While this model is more complex, glaucoma specialists benefit from focusing their efforts on those who most need their care, optometrists benefit from easy access to glaucoma specialists for consultation, and both groups benefit in a collaborative model without risk of patient attrition to either practice.…”

Section: Discussionmentioning

confidence: 99%

Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic

Stanley

Huisingh

Swain

et al. 2018

Journal of Glaucoma

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Purpose: To determine the level of adherence to the American Academy of Ophthalmology (AAO) preferred practice pattern (PPP) guidelines for quality primary open angle glaucoma (POAG) and POAG suspect (POAGS) care among retail-based optometrists. Methods: Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients’ charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis. Results: Of 360 identified patients, ten elements were documented in over 98%. Documentation of the remaining five components was as follows: dilated fundus exam (DFE) 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target intraocular pressure (IOP) 15.6%. 32.8% of patients were seen once while the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history (100.0% versus 97.5%, P=0.0346), review of systems (100.0% v. 97.5%, P=0.0346), gonioscopy (60.0% v. 22.0%, P<0.001), CCT (94.2% v. 77.1%, P<0.001), visual field (97.5% v. 40.7%, P<0.001), and target IOP (22.4% v. 1.7%, P<0.001) compared to single visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing (92.7% v. 68.9%, P<0.001) and had an established target IOP (35.1% v. 1.4%, P<0.001) compared to POAGS patients. Conclusions: Compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing DFE, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.

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Section: Discussionmentioning

confidence: 99%

Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic

Stanley

Huisingh

Swain

et al. 2018

Journal of Glaucoma

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“…These results add to the growing body of evidence showing that a team approach provides an effective solution for managing the ongoing care burden in chronic stable glaucoma cases at low risk of vision loss for the benefit of patient outcomes [ 6 7 25 ]. Contrary to other vertical integrated care schemes, which typically shift pre-existing, stable patients from a public hospital outpatients department to a community care model, patients in this scheme were identified and referred directly by primary care providers.…”

Section: Discussionmentioning

confidence: 89%

“…One patient with a mean deviation positive progression rate of +7.4dB/year was excluded from the analysis. A patient with a progression rate worse than -1dB/year was considered a "fast progressor" and the total number of patients with a negative slope of mean deviation values (indicating any progression) was also identified [24]. Further details on the study coding protocol are provided in supplementary file 2.…”

Section: Data Collectionmentioning

confidence: 99%

Glaucoma Community Care: Does Ongoing Shared Care Work?

Ly¹,

Wong²,

Huang³

et al. 2020

Int J Integr Care

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We assessed a novel, public, vertical integrated care model for glaucoma management in the community. Methods: This study was a retrospective, longitudinal study of 266 patients diagnosed or suspected of glaucoma. Patients were stratified to either ongoing ophthalmology-led (n = 81) or optometry-led shared care (n = 185). Demographics and clinical characteristics, including the re-referral rate and timeliness of follow up were analysed. Results: Just under half (565/1224, 46%) of all follow up consultations over the total study period of 45 months were seen in optometry-led care, with a re-referral rate to ophthalmology of 21%. Treated patients showed a median intraocular pressure reduction of 20% and a median time delay of just two days between the actual and recommended review period. Conclusions: Shared care provides an effective option for managing the ongoing care burden in chronic stable glaucoma cases at low risk of vision loss.

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“…These articles compared the performance of the non-medical staff with that of the GE, or compared SC in general with StC [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. All articles concentrated on an actual clinic performing SC, including the glaucoma follow-up unit in the Rotterdam Eye Hospital (SC-GFU) [ 36 , 37 , 38 ], the Mayo clinic (SC-MC) [ 33 , 34 , 35 ], the Moorfield Eye Hospital (SC-MEH) [ 40 , 42 ], the Queen’s medical centre (SC-QMC) [ 39 ], the Stable Glaucoma Clinic in New Zealand (SC-SGC) [ 43 ], the Glaucoma Management Clinic in Australia (SC-GMC) [ 44 ] and one established between the Royal Victorian Eye & Ear Hospital and the Australian College of Optometry (SC-RVAC) [ 41 ]. The corresponding StC clinic in each hospital is referred as “StC—(name of the corresponding clinic/hospital)”.…”

Section: Results Of Shared Care Studiesmentioning

confidence: 99%

“…The Mayo Clinic showed an increase in compliance on initial testing to the American Academy of Ophthalmology Preferred Practice Pattern (AAO PPP) guidelines [ 45 ] after implementation of the SC-MC [ 35 ]. Similarly, the SC-RVAC [ 41 ] showed a high compliance to both the AAO PPP [ 45 ] and the ANGIG&RANZCO recommendations [ 28 ].…”

Section: Results Of Shared Care Studiesmentioning

confidence: 99%

Shared Care and Virtual Clinics for Glaucoma in a Hospital Setting

Simons

Vercauteren

Breda

et al. 2021

JCM

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Glaucoma patients require lifelong management, and the prevalence of glaucoma is expected to increase, resulting in capacity problems in many hospital eye departments. New models of care delivery are needed to offer requisite capacity. This review evaluates two alternative schemes for glaucoma care within a hospital, i.e., shared care (SC) and virtual clinics (VCs), whereby non-medical staff are entrusted with more responsibilities, and compares these schemes with the “traditional” ophthalmologist-led outpatient service (standard care). A literature search was conducted in three large bibliographic databases (PubMed, Embase, and Trip), and the abstracts from the prior five annual meetings of the Association for Research in Vision and Ophthalmology were consulted. Twenty-nine were included in the review (14 on SC and 15 on VCs). Patients with low risk of vision loss were considered suitable for these approaches. Among the non-medical staff, optometrists were the most frequently involved. The quality of both schemes was good and improved with the non-medical staff being trained in glaucoma care. No evidence was found on patients feeling disadvantaged by the lack of a doctor visit. Both schemes increased the hospital’s efficiency. Both SC and VCs are promising approaches to tackle the upcoming capacity problems of hospital-based glaucoma care.

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Analysis of a Physician-led, Team-based Care Model for the Treatment of Glaucoma

Abstract: An increase in compliance with AAO guidelines was found after implementation of our protocol for a physician-led, team-based care model to standardize glaucoma care among providers.

Cited by 6 publications

References 16 publications

Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic

Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic

Glaucoma Community Care: Does Ongoing Shared Care Work?

Shared Care and Virtual Clinics for Glaucoma in a Hospital Setting

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