Improving Patient Access and Reducing Costs for Glaucoma with Integrated Hospital and Community Care: A Case Study from Australia

International Journal of Integrated Care

Gerald Liew¹  Blake Angell²  Lisa J. Keay²  Belinda K. Ford³  Andrew J. R. White³ 

[1] Department of Ophthalmology Westmead Hospital, Sydney, NSW;Faculty of Medicine, UNSW, Sydney, NSW;The George Institute for Global Health, Sydney, NSW;

关键词: collaborative eye care;    health service efficiency;    cost saving;    task-shifting;    chronic eye disease;    models of care;   

DOI  :  10.5334/ijic.4642

来源: DOAJ

【 摘 要 】

Introduction: Glaucoma, a chronic eye disease requires regular monitoring and treatment to prevent vision-loss. In Australia, most public ophthalmology departments are overburdened. Community Eye Care is a ‘collaborative’ care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. C-EYE-C was implemented at one Australian hospital. This study aims to determine whether C-EYE-C improves access to care and better utilises resources, compared to hospital-based care. Methods: A clinical and financial audit was conducted to compare access to care and health system costs for hospital care and C-EYE-C. Attendance, wait-time, patient outcomes, and the average cost per encounter were calculated. A weighted kappa assessed agreement between the optometrist and ophthalmologist decisions. Results: There were 503 low-risk referrals, hospital (n = 182) and C-EYE-C (n = 321). C-EYE-C had higher attendance (81.6% vs 68.7%, p = 0.001); and shorter appointment wait-time (89 vs 386 days, p < 0.001). Following C-EYE-C, 57% of patients avoided hospital; with 39% requiring glaucoma management. C-EYE-C costs were 22% less than hospital care. There was substantial agreement between optometrists and ophthalmologist for diagnosis (k = 0.69, CI 0.61–0.76) and management (k = 0.66, CI 0.57–0.74). Discussion: C-EYE-C showed higher attendance, and reduced wait-times and health system costs. Conclusions: Upscale of the C-EYE-C model should be considered to further improve capacity of public eye services in Australia.

【 授权许可】

Unknown