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Eye Disease > Glaucoma 7 - Referral Filtering Pathway > Flashcards

Glaucoma 7 - Referral Filtering Pathway Flashcards

1
Q

why do we have GLAUCOMA REFERRAL FILTERING AND CO-MANAGEMENT BY OPTOMETRISTS?

A

-increased burden on NHS services (ophthlamology outpatients)
-shortage of Ophthalmologists
-ageing population= greater glauc load

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2
Q

how much does Glaucoma account for eye outpatient attendances in UK

A

25%

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3
Q

how do we increase Diagnostic accuracy of optometrists’ referrals for suspect glaucoma

A

by repeating and refining measurements

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4
Q

what has been put into place to minimise unecessary HES referrals?

A

“Two-tier” testing increases specificity by reducing false positives of case detection by reducing false positives = repeating and refining measurement

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5
Q

what factors are monitored on the Glaucoma scheme?

A
  • demographic factors:population growth, life expectancy and ageing
  • other factors: targets, requirements for training/supervision, guidelines
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6
Q

what have been some challenges of the Glaucoma scheme?

A
  • px safety issues
  • 7million apts (2014-15)
  • 20 patients a month unnecessarily losing sight as a result of delays-increasing figure due to covid
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7
Q

which country in the EU has the least qualified Ophthalmologists

A

the UK (Can be due to stricter rules on qualifying)

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8
Q

is there a good potential for Optometry in glauc shared care?

A

yes as:
-Large profession *~14,000 and growing!
-Extended role interest- community and Hospital presence
-Post-graduate specialist training- Glaucoma, IP etc
-Economics- it is cost effective

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9
Q

what is the difference between england and scotland eye services?

A

scotland= 2006-more enhanced services, NHS covers all eyetests
(Optoms are required to do more though)

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10
Q

according to Tuck 1991; Tuck and Crick 1991, which medical professionals initiate most referrals and what three tests are conducted prior to the referral process?

A

Optometrists initiate most referrals;

  1. Optic disc; always
  2. IOP; 1/2 to 2/3 of patients >40yrs
  3. VF; <10% of patients >40yrs
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11
Q

what test specifically were results (inc false positives) variable between practitioners when referring suspect glauc px?

A

visual fields

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12
Q

what are the names of two Glaucoma referral refinement schemes?

A

-DoH National Eye Care Services Steering Group (2002)
-MREH glaucoma referral refinement scheme – GERS (2000)

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13
Q

what were the three objectives of the two Glaucoma referral refinement schemes?

A
  1. reduce number of false positive glaucoma referrals to HES
  2. reduce waiting times between GP referral & glaucoma evaluation
  3. greater involvement of primary care sector
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14
Q

how has the Manchester GRR Scheme (now termed enhanced case finding service (GERS) been refined from the old to newer pathway?

A

involvement of accredited community optometrist- can be asked to include gonioscopy

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15
Q

state some advantages of the Manchester GERS PATHWAY

A
  • reduced waiting times (Seen within 2 wks by accredited optom)
  • reduced number of false positives AND false negatives
  • px seen in primary care esp if slow growth + good prognosis
  • increased capacity in HES
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16
Q

how have referrals in Scotland improved after the new GOS contract?

A
  • Decrease in false positive referrals
  • ↑ number of referrals with info on GAT
  • ↑ number of referrals with info on dilated exam
  • ↑ number of referrals with info on repeat VF
  • Training provided and undertaken since
17
Q

what is included in the referral guidelines for glauc?

A
  • High IOPS
  • Age
  • CCT
18
Q

What are some of the key tests stated to do before referring in the 2017 referral guidance of Glaucoma?

A
  • visual fields
  • iops using goldmann
  • disc assessment
  • gonioscopy or VH
19
Q

According to the 2017 referral guidance of Glaucoma, can we refer based solely on non-contact tonometry?

A

nope

20
Q

what is the IOP threshold for referral using goldmann?

A

24mm/hg or above- repeated IOPS at different time of day is recommended though

21
Q

can we refer suspect COAG who have previously been sent to HES?

A

No, unless any changes have been noticed since the previous referral

22
Q

Are Glaucoma Repeat measures, enhanced case finding, referral refinement, glaucoma co-management services all the same thing?

A

No:

  • Referral filtering (refinement/enhanced case finding/repeat measurement services) = BEFORE px are referred
  • Co-management services = px who have ALREADY been referred as suspect glu or OHT
23
Q

what is the definition of shared care schemes?

A

Sharing of clinical management responsibilities between two or more health care professionals in HES or community

24
Q

what was found in the RCT of Bristol Shared care glauc study between HES and community optoms?

*there was a low eligibility (only 2780 participants) due to inclusion criteria

A
  • equally reliable
  • outcomes comparable
  • High patient satisfaction for HES and community optometrists
  • Costs lower in HES
25
Q

what is an example of a shared care model (used by GERS)

A

stable (maybe suspect) patients are monitored by community optometrists in practice, and return/referred to the ophthalmologist in the Hospital Eye Service (HES) if their condition worsens

26
Q

in what eye condition was shared care first used and what else is it used in now?

A

first used in diab retionpathy, extended into
-OHT/open angle glauc
-LV
-Cataract

27
Q

advs of shared care schemes

A
  • improve the quality and equality of patient care
  • Reduces pressure on outpatient waiting lists
  • Reduced waiting times
  • May save money - but costs of scheme doesnt make this a strong one
  • Patients may prefer to visit community optometrist rather than hospital
  • Greater integration of primary and secondary care
  • Multidisciplinary co-operation
28
Q

which healthcare professional would see a px with medical glaucoma?

A

ophthalmologist only or optometrist under opthalmologist guidance

29
Q

which healthcare professional would see a px with ‘Complex’ glaucoma

A

ophthalmologist

30
Q

what are 5 way a patient can get their glaucoma prescription?

A
  • requested from the GP
  • Optometric Supplementary Prescribing Formulary
  • Optometric Independent Prescribing Formulary
  • Patient Group Directive
  • written by a medical colleague
30
Q

which clinic has the highest amount of supervision?

A

glaucoma

31
Q

what training and accreditation is available for optometrists to take part in these schemes?

A
  • College of Optometrists ‘new’ Higher Qualifications
  • Certificate/Higher Certificate/Diploma in Glaucoma
  • Independent Prescribing GOC & Specialty Registration
  • Local Optical Support Unit (LOCSU) Pathway
32
Q

case studies at end

A

case studies at end

33
Q

The definition of “shared care” can mean different things to different people, what are three examples of what it can mean?

A
  • data collection only
  • data collection and decision making by protocol
  • data collection and decision making on there professional opinion

Eye Disease (48 decks)

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