None listed
Conditions
Brief summary
Vision related problems, commonly associated with increasing age and chronic disease burden, amount to $16 billion annual costs in Australia and challenge the provision of cost-effective, accessible, and timely care for patients with chronic disorders. Visual impairment and blindness as a consequence of diabetes have increased by 64% and 27% respectively worldwide between 1990 and 2010. In Australia, diabetes is the leading cause of blindness in working-age people. Referral refinement schemes and shared-care models have recently been implemented internationally to manage patients with glaucoma, and alternative care pathways for other conditions have been investigated. 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. TSH provides care to a large cohort of patients with diabetes, typically under the care of an endocrinologist, many currently do not receive appropriate levels of eye care. Patients also have access to an integrated care unit (HealthOne), which provides diabetes education, health and legal advice. In collaboration with CFEH, TSH recently established a hospital-based ophthalmology-optometry collaborative care clinic in Australia as part of this multidisciplinary team to make eye health care available to all patients with diabetes and support the development of integrated patient management between general practitioners, specialists and allied health professionals. This study will investigate a novel hospital-based ophthalmology-optometry collaborative care model to prevent vision related complications in patients suffering from diabetes. Successful implementation of this model would not only reduce the incidence of sight-threatening diabetic retinopathy in Australia, but provide a foundation for the provision of sustainable, accessible, and efficient eye health care for patients with diabetes. To investigate the potential of this model within the current setting as well as its potential for implementation in other hospitals, we will assess: • suitability of patients for shared care; • clinical status and demographic characteristics of patient cohorts; • patient satisfaction and quality of life; • cost analysis of the new model.
Interventions
Intervention is provided through a clinical assessment for diabetic retinopathy at the Sutherland Hospital ophthalmology department in the form of a face-to-face consult with an attending ophthalmologist. The assessment will consist of standard clinical care including, but not limited to, patient history, VA assessment, pupil assessment, slit lamp examination, tonometry, pupil dilation, Optomap imaging, retinal photography, or optical coherence tomography as clinically appropriate. Time of the i
Intervention is provided through a clinical assessment for diabetic retinopathy at the Sutherland Hospital ophthalmology department in the form of a face-to-face consult with an attending ophthalmologist. The assessment will consist of standard clinical care including, but not limited to, patient history, VA assessment, pupil assessment, slit lamp examination, tonometry, pupil dilation, Optomap imaging, retinal photography, or optical coherence tomography as clinically appropriate. Time of the intervention will vary, but is expected to take 1-2 hours.
Sponsors
Centre for Eye Health, Unversity of New South Wales
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
18 years of age of above Referred to Sutherland Hospital Eye Clinic for diabetic retinopathy assessment Triaged to the CFEH-TSH arm of the clinic for assessment within 4 weeks or longer
Exclusion criteria
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 Patients referred for diabetic retinopathy assessment with acute visual symptoms, unexplained of decreased visual acuity (6/9 or less), maculopathy within 2 optic disc diameter of the foveal centre, severe non-proliferative or any form of proliferative diabetic retinopathy, and all patients with urgent ophthalmic sign such as vitreous haemorrhage, retinal detachment or rubeotic glaucoma
Outcome results
None listed