Lecture 8: Glaucoma referral filtering and co-management by optometrists Flashcards
What type of testing can be used for referral filtering?
two-tier testing
increases specificity of case detection by reducing false positives
-repeat measures
-referral refinement
Why is there an increased demand for glaucoma care?
demographic: population growth, ageing, life expectancy
other factors: requirements for training
What glaucoma refinement schemes are there?
What is the pathway?
What are the advantages?
GERS
enhanced GOS scotland
community optometrist-accredited community optometrist- GP or HES
Reduced waiting times
*seen within 2 weeks by accredited optometrists
*Reduced number of false positives
-confirmatory test and use of all 3 ‘screening’ tests -routine use of GAT and BIO
-clear referral criteria
-training scheme
*Patient seen in primary care
*Increased capacity in HES
What is shared care?
Sharing of clinical management responsibilities between two or more health care professionals from different disciplines
*May be HES or may be community
What are the glaucoma co-management schemes?
One model is:
*stable (and 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
*System was first established for diabetic retinopathy, and has been extended into:
*OHT/open angle glaucoma
*Low vision
* Cataract
What are the advantages of shared care?
-May improve the quality and equality of patient care
*Reduces pressure on ophthalmology outpatient clinic waiting lists
* Reduced waiting times for new patients and follow ups
*May save money (but see “Costs of scheme”)
*Patients may prefer to visit community optometrist rather than hospital
* Analysis of Bristol Shared Care Glaucoma study supports this view
*Greater integration of primary and secondary care
*Multidisciplinary co-operation
What might an entry level optometrist not be able to do?
-May not be competent at van Herick or appreciate anterior segment signs
* May not have seen/appreciated many glaucomatous discs
* May not have adequate experience of VF interpretation
* May not be able to do GAT
* May not have experience of using CCT
* Unlikely to be able to undertake gonioscopy
what post-grad training is available?
College of Optometrists ‘new’ Higher Qualifications *Certificate/Higher Certificate/Diploma in Glaucoma
*Independent Prescribing GOC & Specialty Registration
*Local Optical Support Unit (LOCSU) Pathway
