Abstract
Purpose :
An ageing population coupled with age-increasing prevalence of many ocular conditions poses a challenge for health systems. A new eyecare system was introduced in Scotland in 2006; shifting the management of patients with minor eye conditions from an ophthalmology-led hospital service into optometry-led community care. The overarching aim was to allow patients with minor eye conditions to be managed in the community; allowing more serious conditions to be managed in hospital. In Scotland’s largest health board (Greater Glasgow & Clyde) this resulted in patients only accessing the hospital (Acute Referral Clinic (ARC)) following triage in the community (Optometrist or General Medical Practitioner) or via a generic hospital accident and emergency (A&E) route. In this study we examined ARC referrals to determine the (i) number of referrals, (ii) conditions referred and (iii) accuracy of referrals from each route.
Methods :
The clinical records of all ARC patient admissions over a 2 week period in April 2018 were examined, including details of their diagnosis, referral and management/communication pathways. Three distinct triage pathways (Optometry, General Practitioner (GP) and A&E) were compared for referral accuracy and appropriateness. A referral was deemed appropriate if an eye condition was unsuitable for management and treatment in the community.
Results :
400 patients (age 18-95 yrs) were referred to ARC. The proportion of the main conditions examined were Cornea/Anterior Eye (57%), Retina (14.5%), Neuro-ophthalmology (9%) and Glaucoma (4%). 40% of referrals were from community optometry. The accuracy of referral for each group was Optometry 65.8%, GP 52.6% and A&E 61.5%. The percentage of referrals deemed appropriate were: Optometry 77.8%, GP’s 71% and A&E 61.5%. 75 (18.8%) patients were diagnosed with uveitis or keratitis; conditions in these categories (e.g. anterior uveitis, marginal keratitis) are currently treated by a minority of optometrists with extra training.
Conclusions :
The results show that community optometrists’ referrals were accurate and appropriate in the majority of cases seen in the new eyecare scheme. This suggests that delegating the triage of serious eye conditions, as well as the management of minor eye conditions, to community optometry has the potential to relieve the burden on ophthalmology-led eye services. With appropriate training, this might be expanded to other common ocular conditions.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.