Views of glaucoma patients on provision of follow-up care; an assessment of patient preferences by conjoint analysis

Bhargava, J S; Bhan-Bhargava, Archana; Foss, Alexander; King, Anthony J

doi:10.1136/bjo.2008.140483

Cited by 31 publications

(42 citation statements)

References 19 publications

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“…Recruitment to a glaucoma surgery trial has previously been undertaken, 24 although this research was set in a different healthcare context and was for a different patient group (those presenting with asymptomatic early glaucoma). Despite a recent study 25 indicating that glaucoma patients were unconcerned about the form of their treatment, it remains necessary to clarify potential barriers to surgical trial recruitment and to establish glaucoma patients attitudes towards surgical trials in this condition.…”

Section: Introductionmentioning

confidence: 99%

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

Leighton

Lonsdale

Tildsley

et al. 2011

Eye

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Aim The aim of this study is to examine the attitudes of patients, who presented with advanced glaucoma in at least one eye, to participation in a randomised prospective trial comparing primary medical treatment with primary surgical treatment for advanced glaucoma. Methods Patients who had presented with advanced glaucoma (415 dB loss mean deviation on Humphrey visual field testing) in at least one eye were asked to participate. Five focus groups comprising of 4-8 patients and consisting of 29 patients in total were undertaken. The group interviews were conducted by two experienced qualitative researchers, an ophthalmic clinician was present to clarify technical issues. The focus group discussions were taped and transcribed in full, and analysed through a process of familiarisation, open (inductive) coding, theme generation, theme refinement, and thematic mapping. Results Three overarching themes were identified: (1) the extent of patients' knowledge, (2) anxieties about surgery, and (3) concerns about compromised care due to trial involvement; these themes were further classified into eight sub-themes. Conclusions Patients' willingness to participate in randomised clinical studies is significantly connected to their level of comprehension and insight about the medical condition, its treatment, and the research process; misunderstandings about any of these aspects may act as a significant barrier to trial recruitment. Recruitment rates for future randomised trials may be enhanced by ensuring that patients have full and accurate information about the treatment alternatives, and that uncertainty exists for best patient outcomes between treatment options, and reassuring potential participants that the research process, in particular randomisation, will not compromise clinical care.

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Section: Introductionmentioning

confidence: 99%

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

Leighton

Lonsdale

Tildsley

et al. 2011

Eye

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“…Shared care schemes are also attractive to patients who would find it more convenient to be monitored closer to their home. 34,35 In line with previous research, the service users described how they were frustrated at the lack of support and information that they had received about their condition. 36,37 Consequently, they felt that being monitored in the community would enable them to build up a relationship with one optometrist, with whom there would be more of an opportunity to receive better support and information.…”

Section: Views Of Patients and Health Professionals About The Shared mentioning

confidence: 48%

“…This is a new finding, as previous research exploring patient perceptions of shared care for a range of eye conditions has not found this to be an issue. 34,35,39,40 Long-term research has demonstrated that recurrence of neovascular activity is common, 15 and any delay beyond the recommended interval may cause patients to unnecessarily lose vision permanently. 12 Given that vision can deteriorate in a short time if nAMD DOI: 10.3310/hta20800 HEALTH TECHNOLOGY ASSESSMENT 2016 VOL.…”

Section: Views Of Patients and Health Professionals About The Shared mentioning

confidence: 99%

“…44,45 It should also be acknowledged that all service users attended the same eye hospital for their nAMD care and some aspects of their care may differ to other hospitals throughout the UK, although the themes relating to current experiences of hospital care have also been highlighted by previous research. 34,36,37 Focus groups were used to explore and understand key issues when considering barriers and facilitators to implementation. Separate rather than mixed focus groups were undertaken to capture any potential interprofessional trust issues which emerged from previous research.…”

Section: Views Of Patients and Health Professionals About The Shared mentioning

confidence: 99%

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The Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual randomised balanced incomplete block trial

Reeves

Scott

Taylor

et al. 2016

Health Technol Assess

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BackgroundPatients with neovascular age-related macular degeneration (nAMD) usually attend regular reviews, even when the disease is quiescent. Reviews are burdensome to health services, patients and carers.ObjectivesTo compare the proportion of correct lesion classifications made by community-based optometrists and ophthalmologists from vignettes of patients; to estimate the cost-effectiveness of community follow-up by optometrists compared with follow-up by ophthalmologists in the Hospital Eye Service (HES); to ascertain views of patients, their representatives, optometrists, ophthalmologists and clinical commissioners on the proposed shared care model.DesignCommunity-based optometrists and ophthalmologists in the HES classified lesions from vignettes comprising clinical information, colour fundus photographs and optical coherence tomography images. Participants’ classifications were validated against experts’ classifications (reference standard).SettingInternet-based application.ParticipantsOphthalmologists had to have ≥ 3 years post-registration experience in ophthalmology, have passed part 1 of the Royal College of Ophthalmologists, Diploma in Ophthalmology or equivalent examination, and have experience in the age-related macular degeneration service. Optometrists had to be fully qualified, be registered with the General Optical Council for ≥ 3 years and not be participating in nAMD shared care.InterventionsThe trial sought to emulate a conventional trial in comparing optometrists’ and ophthalmologists’ decision-making, but vignettes, not patients, were assessed; therefore, there were no interventions. Participants received training prior to assessing vignettes.Main outcome measuresPrimary outcome – correct classification of the activity status of a lesion based on a vignette, compared with a reference standard. Secondary outcomes – frequencies of potentially sight-threatening errors, participants’ judgements about specific lesion components, participant-rated confidence in their decisions and cost-effectiveness of follow-up by community-based optometrists compared with HES ophthalmologists.ResultsIn total, 155 participants registered for the trial; 96 (48 in each professional group) completed training and main assessments and formed the analysis population. Optometrists and ophthalmologists achieved 1702 out of 2016 (84.4%) and 1722 out of 2016 (85.4%) correct classifications, respectively [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.66 to 1.25;p = 0.543]. Optometrists’ decision-making was non-inferior to ophthalmologists’ with respect to the pre-specified limit of 10% absolute difference (0.298 on the odds scale). Frequencies of sight-threatening errors were similar for optometrists and ophthalmologists [57/994 (5.7%) vs. 62/994 (6.2%), OR 0.93, 95% CI 0.55 to 1.57;p = 0.789]. Ophthalmologists assessed lesion components as present less often than optometrists and were more confident about their lesion classifications than optometrists. The mean care-pathway cost for assessment was very similar by group, namely £397.33 for ophthalmologists and £410.78 for optometrists. The optometrist-led monitoring reviews were slightly more costly and less effective than ophthalmologist-led reviews, although the differences were extremely small. There was consensus that optometrist-led monitoring has the potential to reduce clinical workload and be more patient-centred. However, potential barriers are ophthalmologists’ perceptions of optometrists’ competence, the need for clinical training, the ability of the professions to work collaboratively and the financial feasibility of shared care for Clinical Commissioning Groups.ConclusionsThe ability of optometrists to make nAMD retreatment decisions from vignettes is non-inferior to that of ophthalmologists. Various barriers to implementing shared cared for nAMD were identified.Future work recommendationsThe Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES) study web application was robust and could be used for future training or research. The benefit of reducing HES workload was not considered in the economic evaluation. A framework of programme budgeting and marginal analysis could explicitly explore the resource implications of shifting resources within a given health service area, as the benefit of reducing HES workload was not considered in the economic evaluation. Future qualitative research could investigate professional differences of opinion that were identified in multidisciplinary focus groups.Trial registrationCurrent Controlled Trials ISRCTN07479761.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 80. See the NIHR Journals Library website for further project information.

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“…Briefly, CA is a technique that has recently been used in healthcare research particularly to determine patients preferences for service development 11,12 and in ophthalmology to determine patients preferences for treatment of various ophthalmic conditions. [13][14][15] The full concept method of analysis generates a number of profiles or scenarios with the attributes of interest for the service package or product represented. The subject has to evaluate the scenarios and had to make trade-offs to rank the scenarios.…”

Section: Introductionmentioning

confidence: 99%

Determining patient preferences in the management of neovascular age-related macular degeneration: a conjoint analysis

Baxter

Fotheringham

Foss

2016

Eye

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Purpose To determine the opinions from a patient perspective on relevant variables in the delivery of treatment for neovascular age-related macular degeneration (nAMD). Methods Pilot interviews with patients and doctors were conducted to identify what variables in the provision of a nAMD service were important. This led to the generation of two sets of scenario options. Subsequently 100 patients undergoing active treatment for nAMD in the National Health Service University Hospital, United Kingdom underwent interview assessment. They were asked to rank their preferences for provision of their care with reference to these two sets of scenario options. Using conjoint analysis, percentage preferences, and utility scores for each variable in each scenario design were calculated. Results Ninety-five patients completed the preference ranking for both scenarios. Eight patients ranked worse vision as preferable to better vision and were excluded on the basis that they had not understood the task. The results of the remaining 87 patients are presented. The most important factor to patients was having good vision, followed by a one-stop service and less frequent follow up. The least important factors were label status of the drug, cost to the health service, and grade of the injector. Conclusion Patients regard good vision and minimal visits to the hospital above the status of injector, label status of drug, or cost to the NHS.

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Views of glaucoma patients on provision of follow-up care; an assessment of patient preferences by conjoint analysis

Abstract: Patients ideally would like to travel a short distance and be seen by a doctor when being followed up for their glaucoma.

Cited by 31 publications

References 19 publications

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

The Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual randomised balanced incomplete block trial

Determining patient preferences in the management of neovascular age-related macular degeneration: a conjoint analysis

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