School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Department of Paediatric Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia.
Ophthalmic Physiol Opt. 2023 Sep;43(5):997-1006. doi: 10.1111/opo.13160. Epub 2023 May 7.
To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks.
Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care.
One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders.
This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.
为了解决获取障碍问题，探索将医院和社区为基础的护理相结合的儿科眼科护理协作模式。
对 2019 年 4 月至 10 月期间在澳大利亚悉尼一家主要的大都市公立儿童医院向三级儿科眼科诊所的连续转诊情况，以及截至 2020 年 7 月的后续就诊情况进行了回顾，以确定适合社区护理的病例。对眼科保健服务提供者（包括眼科医生、视轴矫正师和验光师）以及服务使用者进行了半结构化电话访谈，以了解他们对服务提供潜在变化的看法。使用 Levesque 医疗保健获取模型和实施研究综合框架（CFIR）对定性数据进行演绎分析，为未来的护理模式提供实施策略。
在审核的 439 例转诊中，有 134 例（30.5%，134/439）被确定为适合社区管理。访谈揭示了与潜在护理模式相关的五个主题，这些主题将支持和促进获取：整合的卫生系统、标准化的护理质量、专业间的信任、多学科治理和以患者为中心的护理。未来实施的主要建议包括：（i）确定和培养临床拥护者，（ii）举办教育会议，（iii）进行当地需求评估，以及（iv）告知当地意见领袖。
本审计突出了在大都市医院中存在的获取障碍和转诊至三级儿科眼科服务的目标不明确问题。与社区从业者的整合被认为是简化服务的一种可接受方式，并确定了可能支持在此环境下成功实施的策略。
