Evaluation of a minor eye conditions scheme delivered by community optometrists

• Published in: BMJ open Vol. 6; no. 8; p. e011832
• Main Authors: Konstantakopoulou, E, Edgar, D F, Harper, R A, Baker, H, Sutton, M, Janikoun, S, Larkin, G, Lawrenson, J G
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 10-08-2016; BMJ Publishing Group
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Collaboration; Community Health Services; Cost analysis; Delivery of Health Care; Eye Diseases - diagnosis; Eye Diseases - therapy; Female; Health services; Hospitals; Humans; Infant; Male; Medical personnel; Middle Aged; Ophthalmology; Optometry; Patient Satisfaction; Patients; Physicians; Referral and Consultation; State Medicine; United Kingdom; Young Adult; United Kingdom > UK; PRIMARY CARE
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-011832

BackgroundThe establishment of minor eye conditions schemes (MECS) within community optometric practices provides a mechanism for the timely assessment of patients presenting with a range of acute eye conditions. This has the potential to reduce waiting times and avoid unnecessary referrals to hospital eye services (HES).ObjectiveTo evaluate the clinical effectiveness, impact on hospital attendances and patient satisfaction with a minor eye service provided by community optometrists.MethodsActivity and outcome data were collected for 12 months in the Lambeth and Lewisham MECS. A patient satisfaction questionnaire was given to patients at the end of their MECS appointment. A retrospective difference-in-differences analysis of hospital activity compared changes in the volume of referrals by general practitioners (GPs) from a period before (April 2011–March 2013) to after (April 2013–March 2015) the introduction of the scheme in Lambeth and Lewisham relative to a neighbouring area (Southwark) where the scheme had not been commissioned. Appropriateness of case management was assessed by consensus using clinical members of the research team.ResultsA total of 2123 patients accessed the scheme. Approximately two-thirds of patients (67.5%) were referred by their GP. The commonest reasons for patients attending for a MECS assessment were ‘red eye’ (36.7% of patients), ‘painful white eye’ (11.1%) and ‘flashes and floaters’ (10.2%). A total of 64.1% of patients were managed in optometric practice and 18.9% were referred to the HES; of these, 89.2% had been appropriately referred. First attendances to HES referred by GPs reduced by 26.8% (95% CI −40.5% to −13.1%) in Lambeth and Lewisham compared to Southwark.ConclusionsThe Lambeth and Lewisham MECS demonstrates clinical effectiveness, reduction in hospital attendances and high patient satisfaction and represents a successful collaboration between commissioners, local HES units and primary healthcare providers.