HTANALYSTS, Sydney, Australia.
School of Optometry and Vision Science, UNSW, Sydney, Australia.
Clin Exp Optom. 2023 Mar;106(2):171-177. doi: 10.1080/08164622.2023.2175602.
Despite evidence showing that optometry-led collaborative glaucoma care can be delivered at reduced cost compared to ophthalmology-based care without compromising patient outcomes, such models of care are not widely practiced in Australia. Ensuring glaucoma patients have equitable access to effective and cost-effective care is a matter of public health importance.
This study examined the feasibility and business case assessment for providing glaucoma care from a community optometry perspective.
Nine optometrists were interviewed in a semi-structured format, focusing on the economic feasibility, barriers, and benefits of collaborative glaucoma care. The Consolidated Framework for Intervention Research was used for thematic data analysis. Costs and revenues associated with providing glaucoma care were sourced from the literature and interviews. A business case model assessing the profitability of glaucoma care in optometric practice was developed.
Thematic analysis revealed concerns over financial viability such that current Medicare Benefits Schedule fees are not sufficient to justify the cost of running a community optometry glaucoma clinic. All participants received a supplementary source of revenue. This finding was confirmed by the business case assessment. Inter-professional trust was perceived to be a key barrier to initiation of collaborative care however was able to be overcome quickly upon commencement of a collaborative care relationship. Optometrists perceived that collaborative care was beneficial to all involved, including patients, ophthalmologists, optometrists, and health payers. There was a perception of a growing divide between clinical and retail optometry, which was thought by most participants to be appropriate.
This study is the first to explore the feasibility and business case for community-based optometrists to provide collaborative glaucoma care in Australia. Our findings show that current public funding is insufficient to justify the business case to private optometry practice, despite being perceived by optometrists as beneficial to all involved.
尽管有证据表明，与基于眼科的护理相比，由视光师主导的合作性青光眼护理可以以较低的成本提供，且不会影响患者的结果，但这种护理模式在澳大利亚并没有得到广泛应用。确保青光眼患者能够公平地获得有效且具有成本效益的护理，是一个具有公共卫生重要性的问题。
本研究从社区视光的角度检查了提供青光眼护理的可行性和商业案例评估。
以半结构化的方式对 9 名视光师进行了访谈，重点关注合作性青光眼护理的经济可行性、障碍和益处。使用综合干预研究框架进行主题数据分析。与提供青光眼护理相关的成本和收入均来自文献和访谈。开发了一个评估社区视光实践中青光眼护理盈利能力的商业案例模型。
主题分析揭示了对财务可行性的关注，即当前的医疗保险福利计划费用不足以证明运行社区视光青光眼诊所的成本是合理的。所有参与者都获得了额外的收入来源。这一发现得到了商业案例评估的证实。专业间的信任被认为是启动合作护理的一个关键障碍，但在合作护理关系开始后很快就被克服了。视光师认为合作护理对所有相关方都有益，包括患者、眼科医生、视光师和医疗保健支付方。有一种观点认为，临床视光和零售视光之间的差距越来越大，大多数参与者认为这是合适的。
本研究首次探讨了澳大利亚社区视光师提供合作性青光眼护理的可行性和商业案例。我们的研究结果表明，尽管视光师认为这对所有相关方都有益，但目前的公共资金不足以证明向私人视光实践提供商业案例是合理的。
