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Sharon Ann Bentley, Catherine Green, Linda Malesic, Tracy Siggins, Clare Escott, Maureen O'Keefe, Caroline Clarke; Establishing a collaborative model of glaucoma care in an Australian public hospital setting. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1020.
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Managing the growing number of patients with glaucoma or suspect glaucoma is challenging the capacity of the Australian public health care system. The aim was to establish an effective and efficient new model of collaborative glaucoma care based on Royal Australian and New Zealand College of Ophthalmology (RANZCO) guidelines.
A collaborative clinic was established between the Royal Victorian Eye & Ear Hospital (E&E) and the Australian College of Optometry (ACO) in April 2016, funded by the State Government. An integrated team-based approach involving ophthalmologists, optometrists and orthoptists was taken. The service, operating one half day per week at the ACO, targeted low risk patients from the E&E waitlist. Data were collected on attendance, referrals, waitlists, compliance with American Academy of Ophthalmology Preferred Practice Patterns and RANZCO guidelines (audit of records), optic nerve assessment skills (% correct diagnosis on the validated ‘Glaucomatous Optic Neuropathy Examination’ program) and costs. Surveys were used to evaluate patient and clinician experiences.
A total of 1,408 patients from the E&E waitlist met the eligibility criteria, of which 1,024 were examined in the collaborative clinic over the first 17-month pilot period. Sixty-two percent either had no glaucoma (10%), or were low risk suspects (40%) or high risk suspects (12%), with the remainder having primary open angle glaucoma (22%), another type of glaucoma (9%), ocular hypertension (3%), or other diagnosis (4%). More than three quarters (76%) were discharged to community-based optometry review and 16% were re-referred to the E&E. The E&E new patient glaucoma waitlist was reduced by 32% at 17 months and by 92% at 28 months. Compliance with practice guidelines was greater than 85%. Optic nerve assessment skills improved (mean change 14%; P < 0.05). Of the 72 patients who responded to the survey, 95% preferred to have been seen in the collaborative clinic rather than have remained on the waitlist. All clinicians believed it was a valuable opportunity to share knowledge and 82% said that they would like to continue.
A collaborative clinic for low risk glaucoma patients based on RANZCO guidelines can provide effective patient-centred care, facilitate community-based follow-up when appropriate and reduce hospital glaucoma waitlists, improving access to hospital care for higher risk patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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