Evaluation of a hospital-based integrated model of eye care for diabetic retinopathy assessment: a multimethod study

Abstract

ObjectivesDiabetic eye disease is a leading cause of blindness but can be mitigated by regular eye assessment. A framework of issues, developed from the literature of barriers to eye assessment, was used to structure an examination of perceptions of a new model of care for diabetic retinopathy from the perspective of staff using the model, and health professionals referring patients to the new service.DesignMultimethod: interviews and focus groups, and a separate survey.SettingA new clinic based on an integrated model of care was established at a hospital in outer metropolitan Sydney, Australia in 2017. Funded jointly by Centre for Eye Health (CFEH) and the hospital, the clinic was equipped and staffed by optometrists who work alongside the ophthalmologists in the existing hospital eye clinic.ParticipantsFive (of seven) hospital staff working in the clinic (ophthalmologists and administrative officers) or referring to it from other departments (endocrinologists); nine optometrists from CFEH who developed or worked in the clinic; 10 community-based optometrists as potential referrers.ResultsThe new clinic was considered to have addressed known barriers to eye assessment, including access, assistance for patients unable/unwilling to organise eye checks and efficient management of human resources. The clinic optimised known drivers of this model of care: providing clear scope of practice and protocols for shared care between optometrists and ophthalmologists, good communication between referrers and eye professionals and a collegial approach promoting interprofessional trust. Remaining areas of concern were few referrals from general practitioners, fewer referrals from hospital endocrinologists than expected and issues with stretched administrative capacity. There were also perceived mismatches between the priorities of hospital management and aims of the clinic.ConclusionsThe new model was considered to have addressed many of the barriers to assessment. While there remain issues with the model, there were also unexpected benefits.

Implementation and scalability of shared care models for chronic eye disease: a realist assessment informed by health system stakeholders in Finland, the United Kingdom, and Australia

“…Similar core components exist in shared care initiatives used in eye care and other health disciplines. This includes supervision, training or upskilling workforce [ 20 , 22 ]; well-defined scope of practice [ 20 , 23 ]; protocols [ 20 , 22 , 23 ]; and service integration [ 21 , 22 , 24 ]. Information technology is recognized as an essential component for team communication [ 23 , 24 ].…”

Experiences of Patients With Diabetes Attending a Publicly Funded Eye Care Pathway in Western Sydney: A Qualitative Study

“…Such schemes might also offer a better patient experience by delivering care in more acceptable locations, with greater access to transport or reduced travel times (27). Another benefit of these schemes is that they offer enhanced communication between referring providers, which is often a shortcoming in hospital care (8,31). In the current study, patients held a firm expectation that this was already happening, which might be attributed to their passive trust that the healthcare providers act in their best interest to guide them to appropriate care.…”

Laser Treatment Modalities for Diabetic Retinopathy

“…Readers are used for analyzing the pictures of the fundus and identifying structural features of DR and also seek predictions about the risk of loss of sight based on its severity [ 23 ]. It has been observed that there is a reduction in the number of patients with vision loss pertaining to DR due to improved and timely examination of people with diabetes along with an improvement in glycemic control [ 24 ].…”