Expanding community eye care for glaucoma

Title: Expanding community eye care for glaucoma: a pilot Ophthalmic Diagnostic and Treatment Centre

Author: Helen Lee; Publisher: RNIB; Year of Publication: 2015 

Background

Glaucoma is the second most common cause of certified sight loss in the UK. 3,291 people in England and 192 people in Wales aged over 40 were certified as visually impaired due to glaucoma, between 1 April 2012 and 31st March 2013. With early detection and treatment of ocular hypertension and glaucoma visual field loss can often be prevented or minimized. There is an association between people experiencing high rates of socioeconomic deprivation and presenting in health care settings with advanced glaucoma.

There is increasing demand on ophthalmology departments but without increasing resource this has led to a serious problem of lack of capacity. This has resulted in follow-up appointments being delayed and many incidences of patients not receiving appropriate treatment in a timely fashion. Recent research conducted for RNIB Cymru found Consultant Ophthalmologists in six Welsh Health Boards stating that patients are losing their sight due to excessive waiting times.

In 2011 RNIB began work with Cwm Taf Health Board in South Wales to explore barriers to accessing eye care services and identify potential interventions to prevent avoidable sight loss. Public Health Wales conducted an eye health equity profile and Shared Intelligence undertook qualitative research with service users and service providers. Informed by these pieces of work it was agreed that RNIB and Cwm Taf Health Board would work in partnership to pilot a new service for people with ocular hypertension and ‘stable’ glaucoma. The service is called an Ophthalmic Diagnostic and Treatment Centre (ODTC).

The development and implementation of ODTCs to help manage capacity issues within ophthalmology departments and improve the patient pathway is central to the Welsh Government’s, five year Eye Health Care Delivery Plan (2013). This pilot project was designed to gather learning prior to the roll out of ODTCs; to consider patient flow, assess impact on quality of service, patient satisfaction, waiting times and attendance at both the ODCT and consultant led ophthalmology clinics.

Key findings from the evaluation

With the successful implementation of an optometry-led Ophthalmic Diagnostic and Treatment Centre (ODTC) for glaucoma:

  • Waiting times between appointments were reduced.
  • The hospital rescheduled fewer appointments in general ophthalmology outpatient clinics. Although one in four appointments at the ODTC were rescheduled adding, on average, 29 days between appointments.
  • Patient satisfaction with the ODTC was almost universal. 

The lack of readily available routine data with which to identify glaucoma patients and their appointment activity presented challenges to the evaluation of the pilot.

The actual cost of the ODTC pilot was £291.56 per patient seen; this includes significant staff training costs. Without training costs, and assuming the ODTC was to operate at full capacity with no DNAs (did not attend) the cost would be £122.48 per patient. 

Further resources