Certification for vision impairment: researching perceptions, processes and practicalities in health and social care professionals and patients

Abstract

ObjectivesTo explore the patient experience, and the role of ophthalmologists and other health and social care professionals in the certification and registration processes and examine the main barriers to the timely certification of patients.DesignQualitative study.SettingTelephone interviews with health and social care professionals and patients in three areas in England.Participants43 health and social care professionals who are part of the certification or registration process. 46 patients certified as severely sight impaired (blind) or sight impaired (partially sighted) within the previous 12 months.ResultsCertification and registration are life changing for patients and the help they receive can substantially improve their lives. Despite this, ophthalmologists often found it difficult to ascertain when it is appropriate to certify patients, particularly for people with long-term conditions. Ophthalmologists varied in their comprehension of the certification process and many regarded certification as the ‘final stage’ in treatment. Administrative procedures meant the process of certification and registration could vary from a few weeks to many months. The avoidable delays in completing certification can be helped by Eye Clinic Liaison Officers (ECLO).ConclusionsA better understanding of the certification and registration processes can help improve standards of support and service provision for people who are severely sighted impaired or sight impaired. Better education and support are required for ophthalmologists in recognising the importance of timely referral for rehabilitative support through certification and registration. ECLOs can improve the process of certification and registration. Finally, better education is needed for patients on the benefits of certification and registration.

Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013

“…A qualitative study conducted on recently certified patients reported that while certification was a life changing event, the help they received as a result substantially improved their lives. 12 It is important to note that certification figures closely reflect new registrations with local authority Social Services registers but there remains uncertainty as to how well certification data map to the actual burden of sight loss in the population. 13,14 CVI data are, however, the source for the Public Health Outcome Framework indicators for sight loss in England reported annually online (CVI rates per 100k population at risk for AMD, Glaucoma, and Diabetic Eye Disease) and are also reported by the Welsh government.…”

Support for infants and young people with sight loss: a qualitative study of sight impairment certification and referral to education and social care services

“…Certification and registration is transformative for adults as the referral to social services and the support triggered substantially improves their lives. 1 While for infants and children, social services often have an important role to play, and registration also brings financial and practical benefits to families, the main provider of support is the local authority specialist vision impairment (VI) education service. Early assessment and interventions (eg, low-vision aids) can decrease risks of delayed development in motor, cognitive, language and social domains.…”

“…In addition, it examines the impact of waiting for referrals to education and provides examples of good practice and identifies ways of ensuring prompt referrals. The research follows on from previous research on adults and the CVI and registration process 1 (see box 1 ), whereas the aim of this research was to examine issues related to the certification and registration processes in infants and young people.

The certification and registration processes Certification and registration are two separate processes and involve a number of stages.

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Sight Impairment registration due to stroke—A small yet significant rise?

“…Barriers to certification have been evaluated (Boyce et al., ) and include uncertainty on when to certify, external pressures to reduce certification rates, perception of certification being the end of process rather than a route to services, poor awareness of benefits, incorrect assumptions about patients' views and lack of clarity regarding payment. Boyce and colleagues outline recommendations to address these barriers (). However, the barriers in detection of hemianopia and referral to vision services from stroke units must also be addressed.…”