Comparison of the effectiveness of two enhanced glaucoma referral schemes

Abstract

Purpose: To compare the clinical and financial effectiveness of two optometricled enhanced glaucoma referral schemes in the Bexley Care Trust area. Methods: Over a 12-month period all suspect glaucoma/Ocular Hypertension (OHT) referrals from optometrists relating to patients registered with Bexley GPs were analysed. All these patients were examined under one of two schemes. One was an enhanced glaucoma repeat measurement (EGRM) scheme in which the referring optometrist conducted the repeated tests him/herself prior to referral or non-referral. The alternative was a refinement pathway (RCAS) using a small team of accredited community optometrists. Results: During the full year commencing April 2007, repeat measures using the EGRM scheme resulted in 76% of patients not being referred. In 44.5% of all EGRM patients, where raised intraocular pressure (IOP) was found by noncontact tonometry (NCT), repeated measurement by Goldmann/Perkins applanation tonometry resulted in readings that were <22 mmHg, or that had less than a 5 mmHg difference between the two eyes. Financial review demonstrated that the EGRM achieved 62% savings when compared with HES tariff while RCAS resulted in a saving of 3.5%. Conclusions: Using a primary care repeat measurement scheme to support referral decision-making demonstrated substantial cost benefit while onward referral for refinement by accredited optometrists was essentially cost-neutral compared with HES tariff. Local schemes foster fragmentation and consideration should be given to a service which covers a large population area.

The Peterborough Scheme for Community Specialist Optometrists in Glaucoma: Results of 4 Years of a Two-Tiered Community-Based Assessment and Follow-up Service

“…19 In this study, the number of patients analysed was substantially higher than that reported by some other schemes. 9,10,20 Unlike other schemes, all glaucoma referrals were seen first in the community, regardless of 'low' or 'high' risk. It is felt that this is safe practice given the short waiting times from referral to assessment and the established criteria for referral into HES ( Table 1).…”

Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study)

“…There are emerging models of eye care in the community that try to reduce the number of false-positive referrals to hospital eye services. [53][54][55] Their effectiveness, efficiency and acceptability need to be evaluated in primary research before implementing change. The GATE study provides robust data on how such services might be reconfigured.…”

Clinical model assisting with the collaborative care of glaucoma patients and suspects

“…Collaborative eye‐care delivery models could be an alternative to cope with a growing patient load in combination with a pending shortage of ophthalmologists, and supply the workforce necessary to implement recommended review times for glaucoma patients and suspects . In the UK, refinement schemes have recently been employed including defined criteria for onward referrals of glaucoma patients through primary eye care providers . The introduction of this ‘Community and Hospital Allied Network Glaucoma Evaluation Scheme’ (CHANGES) involved referring glaucoma suspects to optometrists with special interest in glaucoma as a primary step reducing referrals to the hospital eye service by up to 15% and improving turnaround times .…”