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Andrew JR White, Belinda Kate Ford, Blake Angell, Gerald Liew, Lisa Keay; C-EYE-C: Collaborative Care Between Optometrists and Ophthalmologists at a Major Sydney Hospital. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5476. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Community Eye Care (C-EYE-C) uses collaborative care between Westmead Hospital, a major tertiary referral centre in Sydney and community based optometrists to manage low-risk glaucoma patients. This study aims to determine if C-EYE-C improves service efficiency and better utilises health resources, compared to hospital care.
Service efficiency and health system costs were compared for standard hospital care and C-EYE-C. Medical records of newly referred low-risk patients were audited and data captured on attendance, wait-time, diagnosis and management. A cost analysis used hospital and industry estimates for staffing, equipment, infrastructure, and supplies per patient visit. Agreements between the optometrist diagnosis/management and ophthalmologist batch-review were calculated using a weighted kappa.
Between Oct 2013 & Oct 2017, Westmead Hospital received 503 new low-risk referrals for glaucoma. Referrals were booked at the hospital clinic until March 2016 (n=182), after which referrals were booked at the off-site C-EYE-C clinic (n=321). Compared to the hospital model, C-EYE-C patients had a higher attendance rate (82% vs 69%, p=0.001); and shorter median wait-time from referral to first appointment (89 days vs 386 days, p<0.001). Following C-EYE-C assessment, 57% did not need hospital follow up; and 39% were also reviewed at the hospital clinic. The average cost per patient was $171 for the hospital model, and $133 for C-EYE-C model. The agreement between C-EYE-C optometrists and telehealth ophthalmology assessment was 68% (k=0.69, CI 0.61-0.76) for diagnosis, and 79% (k=0.66, CI 0.57-0.74) for management.
C-EYE-C reduced wait-times by 10 months and demonstrated a 22% reduction in health system costs, compared to hospital care. C-EYE-C optometrist assessments reached a high clinical standard comparable to ophthalmologists. Upscale of the C-EYE-C model should be considered to further improve capacity of public eye services in Australia.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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