Ryan Barbara, Jones Mari, Anderson Pippa, Reynolds Rhiannon, Nicholls Rebecca E M, Cullen Katherine, Davies Mark, North Rachel, Molik Bablin, Wallace Carolyn
Aneurin Bevan University Health Board, Newport, UK.
School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
Ophthalmic Physiol Opt. 2025 Jan;45(1):280-293. doi: 10.1111/opo.13397. Epub 2024 Oct 10.
To evaluate the value of enhanced optometric services for managing neovascular age-related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES).
Seven enhanced optometric service pathways in primary care in Wales were assessed with a mixed-methods approach: three for nAMD and four for glaucoma. The methods were a patient-related experience measure (PREM), a Realist Review and Evaluation involving both patients and staff, a discrete event simulation model estimating the economic impact of the pathways and a workforce survey of optometrists to gauge capability and capacity.
Patient-related experience measure responses (802) indicated that primary care experience was comparable to that of HES. Utilising enhanced optometric services in primary care resulted in reduced wait times compared with HES, with suspected nAMD shortened to 4-5 days and glaucoma monitoring to 5 days. Waiting lists were dramatically reduced with primary care-based services to just three people waiting for nAMD and five for glaucoma, compared with 216 and 5691 people, respectively, in HES. Consultant ophthalmologist time was reduced from 57% to 15%-16% for nAMD services and from 48% to 22%-23% for glaucoma services. Integrating enhanced optometric services into primary care incurred a similar cost. The workforce survey confirms that optometrists possess the skills and qualifications and are willing to deliver these enhanced optometric services. The Realist Review and Evaluation revealed that clear patient communication, effective coordination and strong interprofessional communication between optometrists and ophthalmologists along with a shared electronic record are crucial to the success of this change.
Providing enhanced optometric services in primary care for nAMD and glaucoma brings substantial benefits for the UK National Health Service and patients, including reduced waiting times, waiting lists and released HES capacity. The success of this transition hinges on clear patient communication, administrative co-ordination and effective interprofessional communication.
评估在初级保健验光服务中，而非医院眼科服务（HES）中，强化验光服务对管理新生血管性年龄相关性黄斑变性（nAMD）和青光眼的价值。
采用混合方法评估了威尔士初级保健中的七条强化验光服务途径：三条用于nAMD，四条用于青光眼。这些方法包括患者相关体验测量（PREM）、涉及患者和工作人员的现实主义审查与评估、估计这些途径经济影响的离散事件模拟模型以及验光师劳动力调查，以评估能力和容量。
患者相关体验测量的回复（802份）表明，初级保健体验与医院眼科服务相当。与医院眼科服务相比，在初级保健中使用强化验光服务可缩短等待时间，疑似nAMD患者的等待时间缩短至4 - 5天，青光眼监测等待时间缩短至5天。基于初级保健的服务使等候名单大幅减少，nAMD等候者仅3人，青光眼等候者仅5人，而医院眼科服务中分别为216人和5691人。nAMD服务中，眼科顾问医生的时间从57%减少至15% - 16%，青光眼服务中从48%减少至22% - 23%。将强化验光服务整合到初级保健中产生的成本相似。劳动力调查证实验光师具备相关技能和资质，并愿意提供这些强化验光服务。现实主义审查与评估表明，清晰的患者沟通、有效的协调以及验光师与眼科医生之间强大的跨专业沟通以及共享电子记录对于这一变革的成功至关重要。
在初级保健中为nAMD和青光眼提供强化验光服务为英国国民医疗服务体系和患者带来了诸多益处，包括缩短等待时间、减少等候名单以及释放医院眼科服务的容量。这一转变的成功取决于清晰的患者沟通、行政协调和有效的跨专业沟通。
