英国社区验光师实施的轻度眼部疾病计划的临床安全性。
Clinical safety of a minor eye conditions scheme in England delivered by community optometrists.
作者信息
Konstantakopoulou Evgenia, Harper Robert A, Edgar David F, Larkin Genevieve, Janikoun Sarah, Lawrenson John G
机构信息
Division of Optometry and Visual Science, Centre for Applied Vision Research, City University of London, London, UK.
NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
出版信息
BMJ Open Ophthalmol. 2018 Feb 20;3(1):e000125. doi: 10.1136/bmjophth-2017-000125. eCollection 2018.
OBJECTIVE
The aim of this study was to monitor the activity and evaluate the clinical safety of a minor eye conditions scheme (MECS) conducted by accredited community optometrists in Lambeth and Lewisham, London.
METHODS AND ANALYSIS
Optometrists underwent an accredited training programme, including attendance at hospital eye services (HES) clinics. Patients who satisfied certain inclusion criteria were referred to accredited MECS optometrists by their general practitioners (GPs) or could self-refer. Data were extracted from clinical records. A sample of MECS clinical records was graded to assess the quality of the MECS optometrists' clinical management decisions. Referrals to the HES were assessed by the collaborating ophthalmologists and feedback was provided.
RESULTS
A total of 2123 patients (mean age 47 years) were seen over 12 months. Two-thirds of the patients (67.3%) were referred by their GP. The most common reasons for patients needing a MECS assessment were 'red eye' (36.7% of patients), 'painful white eye' (11.1%), 'flashes and floaters' (10.2%); 8.7% of patients had a follow-up appointment. Of the patients seen, 75.1% were retained in the community, 5.7% were referred to their GP and 18.9% were referred to the HES. Of the HES referrals, 49.1% were routine, 22.6% urgent and 28.3% emergency. Of the records reviewed, 94.5% were rated as appropriately managed; 89.2% of the HES referrals were considered appropriate.
CONCLUSION
The findings of this study indicate that optometrists are in a good position to work very safely within the remits of the scheme and to assess risk.
目的
本研究旨在监测一项由伦敦兰贝斯区和刘易舍姆区经认可的社区验光师实施的轻度眼部疾病计划（MECS）的活动情况，并评估其临床安全性。
方法与分析
验光师参加了一项经认可的培训计划，包括到医院眼科服务（HES）诊所实习。符合特定纳入标准的患者由其全科医生（GP）转介给经认可的MECS验光师，或者可以自行转诊。数据从临床记录中提取。对MECS临床记录的一个样本进行评分，以评估MECS验光师临床管理决策的质量。合作的眼科医生对转诊至HES的病例进行评估并提供反馈。
结果
在12个月内共诊治了2123名患者（平均年龄47岁）。三分之二的患者（67.3%）由其GP转诊。患者需要进行MECS评估的最常见原因是“眼红”（占患者的36.7%）、“白眼疼痛”（11.1%）、“闪光和飞蚊症”（10.2%）；8.7%的患者进行了随访预约。在就诊的患者中，75.1%留在社区，5.7%转诊给其GP，18.9%转诊至HES。在转诊至HES的病例中，49.1%为常规转诊，22.6%为紧急转诊，28.3%为急诊转诊。在所审查的记录中，94.5%被评为管理得当；89.2%的转诊至HES的病例被认为是合适的。
结论
本研究结果表明，验光师有能力在该计划范围内非常安全地工作并评估风险。
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