Patterns of adherence to NICE Glaucoma Guidance in two different service delivery models

Abstract

Purpose To assess adherence patterns to the UK National Institute of Health and Clinical Excellence (NICE) guidelines on glaucoma management (2009) in a tertiary referral centre shared care setting and in a district general hospital (DGH) setting. Method We performed a retrospective case note analysis of 200 patients from two centres between January and June 2010. The two centres involved were a consultant-guided teaching hospital optometry-led shared care setting (setting 1) and a consultant-led DGH clinic setting (setting 2). The main outcome measures were compliance with eight of the main NICE guidelines on glaucoma diagnosis and management (2009). Results Both centres showed good adherence to the guidelines regarding the choice of initial treatment (96% vs 100%, settings 1 and 2, respectively) and arranging appropriate monitoring intervals (92% vs 86%). However, significant differences were seen when assessing whether an optic disc image was obtained at the initial visit (74% vs 10%), whether an appropriate initial assessment was performed (96% vs 58%), whether patients' review interval complied with the NICE guidance regardless of hospital cancellations (92% vs 66%), and whether concordance with medication was checked (88% vs 24%) (settings 1 and 2, respectively, Po0.01-Fisher's exact test). Conclusion Our study provides evidence to suggest that a hospital-based shared care service with trained optometrists using assessment sheets compares favourably to non-specialist glaucoma care delivered by ophthalmologists.

Ophthalmologist knowledge of evidence-based medicine and clinical practice guideline recommendations

“…The authors’ previous study on university faculties and clinical residents had similar results 24. Since PubMed, MDConsult and TRIP have specific filters for guidelines, we recommend introducing these filters to practitioners and training them in order to facilitate ‘finding the best clinical practice guidelines’.…”

“…Other studies also reported such a positive attitude towards clinical guidelines 10 23 40 41. A study in the UK shows that adherence to guidelines for initial assessment and choice of treatment and drug by ophthalmologists is good 24. However, the rate of guideline implementation in practice is not acceptable and, according to Ishii,42 there is a clinical gap between knowledge and practice.…”

Effectiveness of UK optometric enhanced eye care services: a realist review of the literature

“…There is good evidence that specialist optometrists, additionally trained in glaucoma, can make appropriate diagnostic and management decisions compared to a sub‐specialist ophthalmologist reference standard …”

Expanding the traditional role of optometry: Current practice patterns and attitudes to enhanced glaucoma services in Ireland

“…With an established base of practices dispersed across the country, optometrists are well placed to redirect some eye care services away from acute hospitals, though there was also a high level of interest in hospital optometry positions. Under the UK's National Health Service (NHS), a number of innovative care pathways have emerged such as repeat measures, 25 referral refinement, 26 and optometry-led hospital-based glaucoma assessment clinics 27 for example, which involve optometrists in the co-management of glaucoma and have proven an effective strategy in dealing with increasing patient numbers.…”