Access to primary and secondary eye care

Title: The barriers and enablers that affect access to primary and secondary eye care across the UK.

Authors: Carol Hayden, Dave Trudinger, Vivien Niblett, Donna-Louise Hurrell, Sarah Donohoe, Ian Richardson and Elaine Applebee; Publisher: RNIB and Shared Intelligence; Year of publication: 2012

Background

In 2011, RNIB commissioned the independent research organisation Shared Intelligence to undertake research to identify the barriers and enablers that affect access to primary and secondary eye care services across England, Wales, Scotland and Northern Ireland.  The research is part of RNIB's Community Engagement Projects, an initiative to pilot a range of evidence based eye health interventions to understand what models can help increase uptake of eye care services and treatment. Shared Intelligence undertook qualitative research with community members, service users and services providers at specific locations in each of the countries to understand what prompts people to attend eye care services and what the barriers to attendance are. This report presents the findings of the research and provides details of the development of a series of intervention strategies to be piloted in each of the sites. The interventions will be launched in spring and summer 2012 and will be evaluated by London School of Hygiene and Tropical medicine. 

Key findings

The research identified key barriers and enablers that affect access to and uptake of eye care services. These can be broadly categorised into factors affecting primary care and secondary care. These include:

1. Barriers and enablers to accessing primary eye care services

Limited community awareness of eye health — the findings indicate there is a limited awareness or understanding of eye health, which is understood almost exclusively in relation to having good or poor sight. Sight, however, is seen as very important – often the most important sense – and there is a fear of blindness. Symptom-led demand for eye examinations — individuals from all communities accessed optometry service primarily in response to deteriorating sight. Symptom-led demand means that eye conditions are not always detected in the early stages, so patients do not access timely treatment. The cost and retail element associated with primary care — the perceived structure and orientation of optometry towards retailing and the sale of glasses appears to encourage the community to view eye examinations (undertaken in retail premises) as different from other primary health prevention.

2. Barriers and enablers to accessing secondary eye care services

Organisation and administration of secondary care services — many patients find the eye care system to be fragmented and confusing. This perception can exacerbate an already anxious experience and create a barrier to subsequent Interaction between clinician and patient — poor patient experiences of interaction within clinicians and other service providers, and consequent lack of information or explanation, can act as significant barriers to patients’ subsequent engagement with secondary care. Conversely, continuity in treatment is likely to encourage attendance.