Evaluation of a minor eye conditions scheme delivered by community optometrists

Abstract

BackgroundThe establishment of minor eye conditions schemes (MECS) within community optometric practices provides a mechanism for the timely assessment of patients presenting with a range of acute eye conditions. This has the potential to reduce waiting times and avoid unnecessary referrals to hospital eye services (HES).ObjectiveTo evaluate the clinical effectiveness, impact on hospital attendances and patient satisfaction with a minor eye service provided by community optometrists.MethodsActivity and outcome data were collected for 12 months in the Lambeth and Lewisham MECS. A patient satisfaction questionnaire was given to patients at the end of their MECS appointment. A retrospective difference-in-differences analysis of hospital activity compared changes in the volume of referrals by general practitioners (GPs) from a period before (April 2011–March 2013) to after (April 2013–March 2015) the introduction of the scheme in Lambeth and Lewisham relative to a neighbouring area (Southwark) where the scheme had not been commissioned. Appropriateness of case management was assessed by consensus using clinical members of the research team.ResultsA total of 2123 patients accessed the scheme. Approximately two-thirds of patients (67.5%) were referred by their GP. The commonest reasons for patients attending for a MECS assessment were ‘red eye’ (36.7% of patients), ‘painful white eye’ (11.1%) and ‘flashes and floaters’ (10.2%). A total of 64.1% of patients were managed in optometric practice and 18.9% were referred to the HES; of these, 89.2% had been appropriately referred. First attendances to HES referred by GPs reduced by 26.8% (95% CI −40.5% to −13.1%) in Lambeth and Lewisham compared to Southwark.ConclusionsThe Lambeth and Lewisham MECS demonstrates clinical effectiveness, reduction in hospital attendances and high patient satisfaction and represents a successful collaboration between commissioners, local HES units and primary healthcare providers.

<p>A Minor Eye Conditions Pilot Delivered by Community Optometrists</p>

“…They reported 64% were managed by the optometrist and discharged after one visit, with a further 10% being discharged following a second appointment. 21 This agrees with our follow up rate. In our study, the follow up was conducted face to face (78%) or over the phone (22%).…”

“…Others have considered the referral appropriateness in terms of the urgency. 21 The HES outcome was checked for each referral received by the hospital and compared to the provisional diagnosis recorded by the optometrist. Patient satisfaction was assessed through a short questionnaire.…”

“…This is in concordance with other enhanced service schemes that have been audited. 8,[21][22][23] A larger pilot in Lambeth and Lewisham ran for two years with 2123 episodes in the analysis. They reported 64% were managed by the optometrist and discharged after one visit, with a further 10% being discharged following a second appointment.…”

General ophthalmic services in Scotland: value for (public) money?

“…showed that localised glaucoma schemes can be clinically effective and safe. Work by Konstantakopoulou et al ., who evaluated another local eye care scheme with a focus on minor eye conditions, also demonstrated clinical effectiveness, safety and high levels of patient satisfaction with such schemes.…”

The urgent need to develop emergency EYE care in the UK: the way forward?

“…[21][22][23] The fear is that increased accessibility will further awaken previously unmet supply-driven demand without improving population-level clinical outcomes, so there is an urgent national need to evaluate whether such schemes produce a cost-effective improvement in EEC delivery.…”