None listed
Conditions
Brief summary
In the face of the progressive disease burden associated with an ageing population, public hospitals must face the challenge of providing cost-effective, accessible, and timely care for patients with chronic disorders, especially so that the need for inpatient care is reduced. Within the eye health care sector, shared care models are increasingly utilized to facilitate comprehensive care for all patients. These models integrate optometrists in the care of patients with chronic stable conditions, or in need of long-term at-risk disease monitoring, thus effectively focusing specialist and hospital care for patients with urgent or complicated conditions. Establishing effective triage and collaborative care schemes, however, requires careful validation to ensure that implemented alternative care pathways improve patient management. The Centre for Eye Health (CFEH) in Sydney has already established active collaboration with the Prince of Wales Hospital (PoWH) eye clinic resulting in a shared-care glaucoma management clinic. The knowledge and expertise gained from this collaboration provide the foundation to initiate the current project aiming at an expansion of the current eye health care model to patients waiting for over 12 months to be seen at the PoWH eye clinic. Successful outcomes will result in significantly reduced wait times for patients leading to timely implementation of patient care plans and improved efficiency with regard to eye health care specialist appointments within the public health system.
Interventions
Patients on the waiting list for "next available" appointment at the Prince of Wales Hospital (POWH) Eye Clinic associated with a current wait time of over 12 months, will be offered an alternative appointment at the Centre for Eye Health (CFEH) as part of an optometry-ophthalmology shared-care arrangement within 4-6 weeks.
The intervention will be delivered face to face in the form of a single clinical appointment at CFEH. Appointments will be delivered by specially trained, therapeutically en
Patients on the waiting list for "next available" appointment at the Prince of Wales Hospital (POWH) Eye Clinic associated with a current wait time of over 12 months, will be offered an alternative appointment at the Centre for Eye Health (CFEH) as part of an optometry-ophthalmology shared-care arrangement within 4-6 weeks. The intervention will be delivered face to face in the form of a single clinical appointment at CFEH. Appointments will be delivered by specially trained, therapeutically endorsed optometrists and clinical data will be reviewed by an ophthalmologist from the POWH prior to completion of a clinical report and patient management recommendation. Duration most commonly will cover 1-2 hours, but exact time frame and procedures are personalised depending on the reason for referral for eye examination by the primary care provider. All examinations will include physical inspection of the eye by an optometrist, visual acuity testing, and slit lamp examination. Other tests will be specific to the specific reason for referral and may include gonioscopy, measurement of the intraocular pressure, central corneal thickness, or visual function. Individual structures of the eye may be imaged using fundus photography, corneal topography, scheinpflug imaging, optical coherence tomography, autofluorescence imaging or ultrasound biomicroscopy.
Sponsors
Centre for Eye Health, Unversity of New South Wales
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Blinded (masking used) (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1) Valid referral for eye examination to the Prince of Wales Hospital Eye Clinic 2) Waiting for a "next available" appointment associated with current wait time of over 12 months in response to the referral 3) Suitable for a potential shared-care appointment as assessed by a senior ophthalmology trainee 4) Written, informed consent provided
Exclusion criteria
1) Insufficient information on the patient referral for appropriate triage 2) Patients with significant neurological or systemic co-morbidities that constitute an immediate medical or ophthalmic emergency, or need to be referred to other specialties or immediately admitted to hospital 3) Patients triaged for an appointment at the Prince of Wales Hospital Eye Clinic other than "next available" 4) No written, informed consent provided
Outcome results
None listed