Collaborative three-tier system could ease patient load

A team of UNSW researchers evaluated a new collaborative syst whereby community optometrists referred patients with suspected macular eye disease to the UNSW-based Centre for Eye Health (CFEH) instead of directly to ophthalmologists, as occurs under the current two-tier syst.Ms Angelica Ly, an optometrist at the CFEH and the lead author of the recently published study, said the research team wanted to develop an evidence base related to the managent of non-urgent cases of macular disease to evaluate the efficacy of inter-optometric referrals.As part of the study, 291 cases were referred to the CFEH between July 2013 and June 2014. The patients were assessed at the CFEH by highly trained optometrists using advanced imaging equipment that detects macular disease. We found that the number of cases without a clear diagnosis was halved, from 47% of referrals to 23%, Ms Ly said. As well, we found only 16% of cases needed to be referred to a face-to-face consultation with an ophthalmologist. The raining 84% of cases could rain under ongoing optometric care, either with their community optometrist or by returning to the CFEH. Ms Ly explained that the increasing incidence of macular disease with age, coupled with an ageing population, had led to unprecedented pressure on eye-care systs in Australia and other developed countries. As a result, the CFEH was investigating pathways to relieve pressure on public hospital ophthalmology departments. There is a need to create efficiencies so that all those requiring ophthalmic assessments are able to be seen, she said. One strategy may include more widespread adoption of innovative optometry-ophthalmology collaborative care models. Optometrists are under-utilised, despite their ability to provide regular monitoring and manage cases with low risk of vision loss. This innovative three-tier model of care is an effective and cost-saving way to make sure people with macular disease get to see the right professionals at the right time. Ms Ly noted that an evidence base on current practice patterns and clinical skill sets of different professional groups would be needed in order for the new three-tier syst to become more widespread. This first study looked at the nature of macular diseases suitable for intermediate-tier optometric care and will be followed up by a companion piece on referral pathways, drawing from the CFEH experience, she stated. The subsequent studies will provide guidance to the practising primary care professional in the form of explicit referral criteria and lists of macular conditions appropriate to the different eye-care tiers. Other work relating to the cost-efficacy of service delivery in glaucoma is currently underway at the Centre and may be adapted to macular disease in the future. The CFEH is a joint initiative between UNSW and Guide Dogs NSW/ACT that aims to improve access to eye care and provide a useful resource to optometrists and ophthalmologists.