Community refinement of glaucoma referrals

Abstract

Aim To describe a Manchester-based glaucoma referral refinement scheme designed to reduce the number of false-positive referrals to the hospital eye service. To report on the first years results of this scheme and its financial costs to the NHS. Methods Patients with suspected glaucoma, instead of being referred to their GP and then on to the hospital eye service, were referred to a group of specially trained community optometrists working to an agreed set of referral criteria. Those patients who did not meet the referral criteria were returned to the referring optometrist, while those who met the referral criteria were referred directly to Manchester Royal Eye Hospital. The patient's GP was informed in all cases. Results The number of suspect glaucoma cases referred to the Manchester Royal Eye Hospital was reduced by 40%. This figure is close to the percentage of false-positive referrals measured at Manchester Royal Eye Hospital prior to the onset of this study. The information accompanying referral has been improved and the scheme produces a small financial cost saving to the NHS of approximately d17 per patient. Conclusion Community refinement of suspect glaucoma offers some important benefits over the current referral pathway.

The influence of the new general ophthalmic services (GOS) contract in optometrist referrals for glaucoma in Scotland

“…12 This was in contrast with another report, which found that the accredited glaucoma optometrists reduced the number of glaucomasuspect referrals to the HES by 40%, and was able to save the NHS approximately d17 per patient. 13 Although the requirements of the new GOS contract was not intended for community optometrists to become specifically trained in glaucoma screening, the increasing prevalence of glaucoma means that the optometrists will be faced with more and more glaucoma-suspect patients. There may be a role for additional local feedback to the community optometrists to improve the accuracy rates of referrals, and thus, it would be worthwhile repeating the study after these results have been disseminated to the northeast of Scotland community optometrists.…”

Glaucoma case finding: a cluster-randomised intervention trial

“…These include the use of referral guidelines 11 and the use of repeat examination by accredited optometrists. 18 We conducted a randomised controlled trial to test an intervention aimed at improving optometrist case-finding through training in optic disc assessment, the provision of explicit referral criteria and ophthalmologist feedback on referred patients. To our knowledge, this was the first time such a study had been undertaken.…”

ReGAE 1: using the Shah–Cross model as an orientating framework in African-Caribbean glaucoma research

“…Additional training in optic disc assessment and glaucoma management could assist in reducing HES referrals and freeing up ophthalmologist time. 21,22 Therefore, investigating case finding and referral patterns, as well as scoping the knowledge and skill development needs among local community optometrists are necessary research activities.…”