The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, 1 King Street Newtown, Sydney, NSW, 2042, Australia.
Westmead Hospital Ophthalmology Department, Corner Hawkesbury and Darcy Rd Westmead, Sydney, NSW, 2145, Australia.
Eye (Lond). 2023 Oct;37(14):2934-2945. doi: 10.1038/s41433-023-02444-9. Epub 2023 Mar 6.
BACKGROUND/OBJECTIVES: Several health systems have implemented innovative models of care which share the management of patients with chronic eye diseases between ophthalmologists and optometrists. These models have demonstrated positive outcomes for health systems including increased access for patients, service efficiency and cost-savings. This study aims to understand factors which support successful implementation and scalability of these models of care.
SUBJECTS/METHODS: Semi-structured interviews were conducted with 21 key health system stakeholders (clinicians, managers, administrators, policy-makers) in Finland, United Kingdom and Australia between October 2018 and February 2020. Data were analyzed using a realist framework to identify the contexts, mechanisms of action, and outcomes of sustained and emerging shared care schemes.
Five key themes relating to successful implementation of shared care were identified as (1) clinician-led solutions, (2) redistributing teams, (3) building inter-disciplinary trust, (4) using evidence for buy-in, and (5) standardized care protocols. Scalability was found to be supported by (6) financial incentives, (7) integrated information systems, (8) local governance, and (9) a need for evidence of longer-term health and economic benefits.
The themes and program theories presented in this paper should be considered when testing and scaling shared eye care schemes to optimize benefits and promote sustainability.
背景/目的：一些卫生系统已经实施了创新的护理模式，这些模式将眼科医生和验光师共同管理慢性眼病患者。这些模式已经证明对卫生系统有积极的影响，包括增加患者的就诊机会、提高服务效率和节省成本。本研究旨在了解支持这些护理模式成功实施和可扩展性的因素。
2018 年 10 月至 2020 年 2 月期间，在芬兰、英国和澳大利亚，对 21 名关键卫生系统利益相关者（临床医生、经理、管理人员、政策制定者）进行了半结构式访谈。使用现实主义框架对数据进行分析，以确定持续和新兴的共享护理计划的背景、作用机制和结果。
确定了与共享护理成功实施相关的五个关键主题，分别是（1）临床医生主导的解决方案，（2）重新分配团队，（3）建立跨学科信任，（4）使用证据获得认可，（5）标准化护理方案。可扩展性得到了以下因素的支持：（6）经济激励，（7）集成信息系统，（8）地方治理，以及（9）需要有更长期的健康和经济效益证据。
在测试和扩展共享眼科护理计划以优化效益和促进可持续性时，应考虑本文提出的主题和方案理论。
