School of Healthcare Sciences, Cardiff University, Cardiff, UK.
School of Health Sciences, City, University of London, London, UK.
Ophthalmic Physiol Opt. 2021 Jul;41(4):864-873. doi: 10.1111/opo.12836. Epub 2021 May 25.
Describe the development, delivery, acceptability and evaluation of a modular training programme for community-based, non-medical practitioners monitoring patients with quiescent neovascular age related macular degeneration (QnAMD). Also, report on a qualitative process evaluation conducted during the pilot phase of a randomised control trial (the FENETRE Study) exploring patient and practitioner acceptability of community-based QnAMD care relative to hospital-based care.
Learning outcomes from The College of Optometrists' Medical Retina higher qualifications and the Royal College of Ophthalmologists' Common Clinical Competency Framework were used to develop a competency framework for QnAMD care. Training was delivered online, comprising six asynchronous lectures followed by two synchronous case-based discussion webinars, with an accredited assessment of 24 case vignettes. An anonymous evaluation survey was conducted with the first two FENETRE cohorts (n = 38). Separately, we undertook a qualitative process evaluation, sampling purposively in four hospitals and five community-based practices, interviewing nine patients and eight practitioners.
Survey responses (n = 26) showed community optometrists were very satisfied (n = 12; 46%) or satisfied (n = 14; 54%) with the training; feedback reflected by qualitative process evaluation data. Overall, optometrists also felt either confident (n = 15; 58%) or very confident (n = 8; 31%) in conducting AMD monitoring appointments following training, a finding also corroborated by interview data from optometrists participating in the initial pilot phase roll-out. Optometrists identified patient convenience and alleviating pressures in hospital care as the primary reasons for acceptability of community pathways. Data from patients entering community practices suggested they largely found this at least as safe and convenient as hospital care, although some patients randomised to hospital care perceived that as safer.
This pilot study has shown the development and implementation of a collaborative community monitoring model is feasible, with satisfaction from community optometrists for training and accreditation, and broad acceptance for the pathway by both patients and practitioners.
描述一个针对社区非医疗从业者监测静止型新生血管性年龄相关性黄斑变性（QnAMD）患者的模块化培训计划的开发、实施、可接受性和评估。此外，报告一项定性过程评估，该评估在一项随机对照试验（FENETRE 研究）的试点阶段进行，该试验探索了社区为基础的 QnAMD 护理相对于医院为基础的护理在患者和从业者中的可接受性。
利用视光学院的高等学历和皇家眼科医师学院的常见临床能力框架的学习成果，为 QnAMD 护理开发了一个能力框架。培训在线进行，包括六个异步讲座，然后是两个基于案例的同步网络研讨会，通过对 24 个案例描述进行认证评估。对前两个 FENETRE 队列（n=38）进行了匿名评估调查。另外，我们进行了一项定性过程评估，在四家医院和五家社区实践中进行了有针对性的抽样，对九名患者和八名从业者进行了访谈。
调查回应（n=26）显示，社区视光师对培训非常满意（n=12；46%）或满意（n=14；54%）；定性过程评估数据反映了反馈。总体而言，视光师在培训后也对进行 AMD 监测预约感到有信心（n=15；58%）或非常有信心（n=8；31%），这一发现也得到了参与初始试点阶段推出的视光师的访谈数据的证实。视光师认为患者的便利性和缓解医院护理的压力是社区途径可接受性的主要原因。进入社区实践的患者数据表明，他们至少发现社区护理同样安全和方便，尽管一些随机分配到医院护理的患者认为医院护理更安全。
这项试点研究表明，协作社区监测模式的开发和实施是可行的，社区视光师对培训和认证感到满意，患者和从业者广泛接受该途径。
