North East, North Central London and Essex Health Innovation & Education Cluster, London, UK.
Ophthalmic Physiol Opt. 2013 Mar;33(2):183-9. doi: 10.1111/opo.12029.
To assess the impact of referral refinement criteria on the number of patients referred to, and first-visit discharges from, the Hospital Eye Service (HES) in relation to the National Institute for Health & Clinical Excellence (NICE) Glaucoma Guidelines, Joint College Group Guidance (JCG) and the NICE commissioning guidance.
All low-risk (one risk factor: suspicious optic disc, abnormal visual field (VF), raised intra-ocular pressure (IOP) (22-28 mmHg) or IOP asymmetry (>5 mmHg) and high-risk (more than one risk factor, shallow anterior chamber or IOP >28 mmHg) referrals to the HES from 2006 to 2011 were analysed. Low-risk referrals were seen by Optometrists with a specialist interest in glaucoma and high-risk referrals were referred directly to the HES.
Two thousand nine hundred and twelve patient records were analysed. The highest Consultant first-visit discharge rates were for referrals based on IOP alone (45% for IOP 22-28 mmHg) and IOP asymmetry (53%), VF defect alone (46%) and for abnormal IOP and VF (54%). The lowest first-visit discharge rates were for referrals for suspicious optic disc (19%) and IOP >28 mmHg (22%). 73% of patients aged 65-80 and 60% of patients aged >80 who were referred by the OSI due to an IOP between 22-28 mmHg would have satisfied the JCG criteria for non-referral. For patients referred with an IOP >28 mmHg and an otherwise normal examination, adherence to the NICE commissioning guidance would have resulted in 6% fewer referrals. In 2010 this scheme reduced the number of patients attending the HES by 15%, which resulted in a saving of £16 258 (13%).
The results support that referrals for a raised IOP alone or in combination with an abnormal VF be classified as low-risk and undergo referral refinement. Adherence to the JCG and the NICE commissioning guidance as onward referral criteria for specialist optometrists in this referral refinement scheme would result in fewer referrals.
评估转诊细化标准对根据国家卫生与临床优化研究所 (NICE) 青光眼指南、联合学院组指南 (JCG) 和 NICE 委托指导，向医院眼科服务 (HES) 转诊的患者数量和首次就诊的出院人数的影响。
分析了 2006 年至 2011 年所有低风险（一个风险因素：可疑视盘、异常视野 (VF)、眼压升高 (22-28mmHg) 或眼压不对称 (>5mmHg) 和高风险（多个风险因素、浅前房或眼压 >28mmHg）向 HES 的转诊。低风险转诊由对青光眼有专门兴趣的验光师进行检查，高风险转诊直接转至 HES。
分析了 2912 名患者的记录。根据眼压 alone (45% for IOP 22-28 mmHg) 和眼压不对称 (53%)、单独 VF 缺陷 (46%) 和异常眼压和 VF (54%)，转诊的顾问首次就诊出院率最高。首次就诊出院率最低的转诊是可疑视盘 (19%) 和眼压 >28mmHg (22%)。由于眼压在 22-28mmHg 之间，OSI 转诊的 73%的 65-80 岁患者和 60%的>80 岁患者将符合 JCG 不转诊标准。对于眼压 >28mmHg 且其他检查正常的患者，遵循 NICE 委托指导将导致转诊减少 6%。2010 年，该方案使 HES 的就诊人数减少了 15%，节省了 16258 英镑（13%）。
结果表明，仅因眼压升高或与异常 VF 结合而转诊应归类为低风险，并进行转诊细化。在这种转诊细化方案中，遵循 JCG 和 NICE 委托指导作为专科视光师的转诊标准，将导致转诊减少。
