Glaucoma Shared Care Model Improves Outcomes

A unique shared care model, between ophthalmologists at Prince of Wales Hospital and optometrists at Centre for Eye Health, is proving to be an effective option for managing ongoing care of patients with chronic stable glaucoma who are at low risk of vision loss.

A paper,¹ published in the International Journal of Integrated Care reports that combining the expertise and resources of optometry and ophthalmology increases outpatient capacity and improves the timeliness of follow up for suitable individuals.

In the long term, by “unclogging the system” and reducing patient wait times, the authors state that “safer, more effective, and more just and equitable access to care” can be achieved.

The retrospective, longitudinal study stratified 266 patients diagnosed or suspected of glaucoma to either ongoing ophthalmology-led (n = 81) or optometry-led shared care (n = 185). The researchers found that under half (565/1224, 46%) of all follow up consultations over the total study period of 45 months were seen in optometry-led care, with a re-referral rate to ophthalmology of 21%. Treated patients showed a median intraocular pressure (IOP) reduction of 20% and a median time delay of just two days between the actual and recommended review period.

The potential to offer shared care is particularly important now, given that the public health system is struggling to meet demand for services, according to  Michael Yapp, Head of Clinical Operations and Teaching at Centre for Eye Health, who said the situation has been further exacerbated by the current COVID-19 environment.

He said, “Transferring patients into a shared care setting assists with ensuring scarce public resources are freed up for more complicated and acute patient care.”

Informal feedback from patients under the shared care model suggests they appreciated the reduced waiting times, both in terms of securing an appointment time and time spent at the appointment.

Although the researchers did not assess any cost savings associated with this shared care model, Mr Yapp said a recently published paper looking at a similar model (Community-Eye-Care) out of Westmead hospital cites costs being 22% less within the shared care system.²

“Shared care programs around Australia are still very much in the early days of development. There is a growing body of evidence that they are effective and efficient. This particular paper looks at ongoing results over time and so shows that the model is an effective option for ongoing as well as initial care. Most importantly, it gives us the numbers to confirm the growing burden of care related to chronic disease management,” said Mr Yapp.

“The 266 patients enrolled in the study typically required five follow up visits over just three years, amounting to 1,224 follow up appointments. It is easy to see how the public system could be easily overwhelmed by this ongoing care demand. As a result, it is hoped that it will lead to consideration of a wider uptake of similar models around the country where appropriate.”

References
1. Ly A, Wong E, Huang J, Yapp M, Masselos K, Hennessy M, et al.. Glaucoma Community Care: Does Ongoing Shared Care Work? International Journal of Integrated Care. 2020;20(3):5. DOI: doi.org/10.5334/ijic.5470

1. Ford, B. K., Angell, B., Liew, G., White, A., & Keay, L. J. Improving Patient Access and Reducing Costs for Glaucoma with Integrated Hospital and Community Care: A Case Study from Australia. International journal of integrated care. 2019;9(4), 5. DOI: doi.org/10.5334/ijic.4642