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Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?

Barbara Ryan Orcid Logo, Mari Jones Orcid Logo, Pippa Anderson, Rhiannon Reynolds, Rebecca E. M. Nicholls, Katherine Cullen Orcid Logo, Mark Davies, Rachel North, Bablin Molik, Carolyn Wallace Orcid Logo

Ophthalmic and Physiological Optics

Swansea University Authors: Mari Jones Orcid Logo, Pippa Anderson, Katherine Cullen Orcid Logo

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DOI (Published version): 10.1111/opo.13397

Abstract

Purpose: To evaluate the value of enhanced optometric services for managing neovascular age‐related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES). Methods: Seven enhanced optometric service pathways in primary care in Wales were a...

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Published in: Ophthalmic and Physiological Optics
ISSN: 0275-5408 1475-1313
Published: Wiley 2024
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spelling v2 67964 2024-10-11 Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care? 8e326860810f5f960b088db10ef58906 0000-0001-9661-4899 Mari Jones Mari Jones true false 128cdedfba6e5e6374fdc85d5c78c428 Pippa Anderson Pippa Anderson true false 9ddf9fac6330356b51fbb9f38fd6081f 0000-0002-3704-4598 Katherine Cullen Katherine Cullen true false 2024-10-11 HSOC Purpose: To evaluate the value of enhanced optometric services for managing neovascular age‐related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES). Methods: Seven enhanced optometric service pathways in primary care in Wales were assessed with a mixed‐methods approach: three for nAMD and four for glaucoma. The methods were a patient‐related experience measure (PREM), a Realist Review and Evaluation involving both patients and staff, a discrete event simulation model estimating the economic impact of the pathways and a workforce survey of optometrists to gauge capability and capacity. Results: Patient‐related experience measure responses (802) indicated that primary care experience was comparable to that of HES. Utilising enhanced optometric services in primary care resulted in reduced wait times compared with HES, with suspected nAMD shortened to 4–5 days and glaucoma monitoring to 5 days. Waiting lists were dramatically reduced with primary care‐based services to just three people waiting for nAMD and five for glaucoma, compared with 216 and 5691 people, respectively, in HES. Consultant ophthalmologist time was reduced from 57% to 15%–16% for nAMD services and from 48% to 22%–23% for glaucoma services. Integrating enhanced optometric services into primary care incurred a similar cost. The workforce survey confirms that optometrists possess the skills and qualifications and are willing to deliver these enhanced optometric services. The Realist Review and Evaluation revealed that clear patient communication, effective coordination and strong interprofessional communication between optometrists and ophthalmologists along with a shared electronic record are crucial to the success of this change. Conclusion: Providing enhanced optometric services in primary care for nAMD and glaucoma brings substantial benefits for the UK National Health Service and patients, including reduced waiting times, waiting lists and released HES capacity. The success of this transition hinges on clear patient communication, administrative co‐ordination and effective interprofessional communication. Journal Article Ophthalmic and Physiological Optics Wiley 0275-5408 1475-1313 Age‐related maculopathy, enhanced optometric service, glaucoma, hospital eye services, primary care, service pathways, value 10 10 2024 2024-10-10 10.1111/opo.13397 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University Another institution paid the OA fee This research was funded by Health and Care Research Wales, Research for Patient Benefit-19-1639. 2024-10-11T13:51:45.9393809 2024-10-11T13:40:15.4261439 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Barbara Ryan 0000-0003-3722-8757 1 Mari Jones 0000-0001-9661-4899 2 Pippa Anderson 3 Rhiannon Reynolds 4 Rebecca E. M. Nicholls 5 Katherine Cullen 0000-0002-3704-4598 6 Mark Davies 7 Rachel North 8 Bablin Molik 9 Carolyn Wallace 0000-0002-3799-5748 10 67964__32597__72c12b6299af43cd99c1bd1a2918a4e5.pdf opo.13397.pdf 2024-10-11T13:40:15.4066818 Output 2946001 application/pdf Version of Record true © 2024 The Author(s). This is an open access article under the terms of the Creative Commons Attribution License (CC BY 4.0). true eng http://creativecommons.org/licenses/by/4.0/
title Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?
spellingShingle Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?
Mari Jones
Pippa Anderson
Katherine Cullen
title_short Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?
title_full Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?
title_fullStr Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?
title_full_unstemmed Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?
title_sort Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?
author_id_str_mv 8e326860810f5f960b088db10ef58906
128cdedfba6e5e6374fdc85d5c78c428
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author_id_fullname_str_mv 8e326860810f5f960b088db10ef58906_***_Mari Jones
128cdedfba6e5e6374fdc85d5c78c428_***_Pippa Anderson
9ddf9fac6330356b51fbb9f38fd6081f_***_Katherine Cullen
author Mari Jones
Pippa Anderson
Katherine Cullen
author2 Barbara Ryan
Mari Jones
Pippa Anderson
Rhiannon Reynolds
Rebecca E. M. Nicholls
Katherine Cullen
Mark Davies
Rachel North
Bablin Molik
Carolyn Wallace
format Journal article
container_title Ophthalmic and Physiological Optics
publishDate 2024
institution Swansea University
issn 0275-5408
1475-1313
doi_str_mv 10.1111/opo.13397
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 1
active_str 0
description Purpose: To evaluate the value of enhanced optometric services for managing neovascular age‐related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES). Methods: Seven enhanced optometric service pathways in primary care in Wales were assessed with a mixed‐methods approach: three for nAMD and four for glaucoma. The methods were a patient‐related experience measure (PREM), a Realist Review and Evaluation involving both patients and staff, a discrete event simulation model estimating the economic impact of the pathways and a workforce survey of optometrists to gauge capability and capacity. Results: Patient‐related experience measure responses (802) indicated that primary care experience was comparable to that of HES. Utilising enhanced optometric services in primary care resulted in reduced wait times compared with HES, with suspected nAMD shortened to 4–5 days and glaucoma monitoring to 5 days. Waiting lists were dramatically reduced with primary care‐based services to just three people waiting for nAMD and five for glaucoma, compared with 216 and 5691 people, respectively, in HES. Consultant ophthalmologist time was reduced from 57% to 15%–16% for nAMD services and from 48% to 22%–23% for glaucoma services. Integrating enhanced optometric services into primary care incurred a similar cost. The workforce survey confirms that optometrists possess the skills and qualifications and are willing to deliver these enhanced optometric services. The Realist Review and Evaluation revealed that clear patient communication, effective coordination and strong interprofessional communication between optometrists and ophthalmologists along with a shared electronic record are crucial to the success of this change. Conclusion: Providing enhanced optometric services in primary care for nAMD and glaucoma brings substantial benefits for the UK National Health Service and patients, including reduced waiting times, waiting lists and released HES capacity. The success of this transition hinges on clear patient communication, administrative co‐ordination and effective interprofessional communication.
published_date 2024-10-10T13:51:43Z
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