Ford Belinda K, Kim Duri, Keay Lisa, White Andrew Jr
Department of Ophthalmology, Westmead Hospital, Sydney, Australia.
The George Institute for Global Health, Faculty of Medicine, The University of New South Wales, Sydney, Australia.
Clin Exp Optom. 2020 Nov;103(6):821-829. doi: 10.1111/cxo.13046. Epub 2020 Feb 5.
Public hospital ophthalmology services are in high demand and patients requiring medical or surgical intervention for glaucoma may worsen while awaiting care. In Australia, tertiary hospital care requires a referral from primary care providers. This study investigates the quality of glaucoma referrals received at a tertiary public hospital in Australia, and describes the types of glaucoma cases referred for hospital management.
An investigation of 200 sequential glaucoma referrals received at a major Australian public hospital from 2013-2016, and the subsequent hospital management. A clinical file audit was made of patient medical records, including referral letters to extract the referral content, and the hospital glaucoma diagnostic outcomes and patient management.
Most referrals came from optometrists (72 per cent) and general practitioners (22 per cent) with the remainder from other specialists. The majority of the referrals contained less than 50 per cent of the key clinical and demographic parameters. Referrals from optometrists provided more ophthalmic information (visual acuity, visual field, intraocular pressure, ocular history). Referrals from general practitioners contained more medical information (systemic co-morbidities medication and allergies). The median wait-time from referral to hospital appointment was 400 days. Of patients attending a hospital appointment, 59 per cent required surgical or medical management, and 16 per cent did not have glaucoma. Overall 18 per cent were discharged, with no differences noted by referral content or referring practitioner.
Most referrals did not include useful diagnostic information on ocular, medical and social risks for glaucoma. There is an opportunity to improve targeting of primary care referrals for glaucoma, since patients who were discharged immediately after their hospital appointment are exacerbating the long hospital wait-time. Better information transfer may help to identify patients requiring more urgent intervention. A standardised referral template and guidelines would support collaborative care and streamline access to hospital services.
公立医院眼科服务需求旺盛，需要进行青光眼药物或手术治疗的患者在等待治疗期间病情可能会恶化。在澳大利亚，三级医院的治疗需要初级医疗服务提供者的转诊。本研究调查了澳大利亚一家三级公立医院收到的青光眼转诊的质量，并描述了转诊至医院进行治疗的青光眼病例类型。
对2013年至2016年期间一家大型澳大利亚公立医院收到的200例连续青光眼转诊病例及其后续的医院治疗情况进行调查。对患者病历进行临床档案审核，包括转诊信以提取转诊内容、医院青光眼诊断结果和患者治疗情况。
大多数转诊来自验光师（72%）和全科医生（22%），其余来自其他专科医生。大多数转诊包含的关键临床和人口统计学参数不到50%。验光师的转诊提供了更多眼科信息（视力、视野、眼压、眼部病史）。全科医生的转诊包含更多医疗信息（全身合并症、药物和过敏情况）。从转诊到医院预约的中位等待时间为400天。在预约就诊的患者中，59%需要手术或药物治疗，16%没有青光眼。总体而言，18%的患者出院，转诊内容或转诊医生未发现差异。
大多数转诊不包括关于青光眼眼部、医疗和社会风险的有用诊断信息。有机会改善青光眼初级医疗转诊的针对性，因为在医院预约后立即出院的患者加剧了医院漫长的等待时间。更好的信息传递可能有助于识别需要更紧急干预的患者。标准化的转诊模板和指南将支持协作护理并简化医院服务的获取。
