Improving efficiency

Shared care can optimise management of glaucoma patients

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Ingeborg Stalmans MD
Strategies involving enhanced technical training of non-physicians can improve efficiency and reduce waiting times for patients with glaucoma, according to Ingeborg Stalmans MD, PhD, University of Leuven (KU Leuven), Belgium. “Shared care can improve quality and increase capacity, and provides a better cost-benefit ratio. It also improves satisfaction at all the levels, from patient to employee to the specialist,” Dr Stalmans told the 12th European Glaucoma Society Congress in Prague, Czech Republic. She noted that efforts she and her associates have undertaken to streamline the triage process in apportioning care in glaucoma have resulted in shorter waiting times and more patients being treated. She added that optimising care for glaucoma is taking on increasing importance as the world’s population grows and ages. The estimated number of glaucoma patients worldwide will rise to 76 million in 2020 and to 112 million in 2040. That, in turn, will lead to capacity saturation, which could in turn result in patients being diagnosed and treated too late to prevent the risk of blindness during their lifetime. The task is therefore not only to ensure that patients get the treatment they require but also to ensure that resources are not wasted on patients who are not yet diagnosed and may not be at risk of blindness during their lifetime, Dr Stalmans emphasised. EVIDENCE-BASED MANAGEMENT Based on evidence from the literature and the European Glaucoma Society’s guidelines, Dr Stalmans and her associates designed an approach to optimising care delivery for glaucoma patients that involved training and certifying non-physician personnel, such as optometric technicians, who then run the Glaucoma Post, a parallel consultation they introduced in 2012. “The aim is to focus the expertise of glaucoma specialists on the newly diagnosed and unstable patients to reduce waiting times for appointments for newly referred patients and research the optimal medical treatment sooner,” she said.
Shared care can improve quality and increase capacity, and provides a better cost-benefit ratio
The examinations they perform include visual acuity testing, intraocular pressure measurement, visual field examination, optic disc and nerve fibre layer imaging (Heidelberg Retinal Tomography/HRT), optical coherence tomography and optic disc photographs. Based on pre-set criteria, the specially trained personnel make a decision of whether they warrant further examination. “They don’t need to do subjective interpretations of these tests, they just have to check whether the patients pass these objective criteria or not,” Dr Stalmans said. If a patient fails in any of the preset parameters, their chart is sent to the specialist who then decides whether it is necessary to see the patient at that point. The glaucoma specialist gives feedback to the person at the Glaucoma Post, helping them to improve their expertise, she noted. “It is very important that these people get a continuous learning process and this is very well appreciated by them as well,” she said. They validated the system based on some key performance indicators in a review of the charts since the introduction of the Glaucoma Posts in 2012. For example, they found that after just one year the number of patients they saw at their outpatient clinics rose from 6,000 to 8,000. In addition, the waiting time for first appointments fell from four-and-a-half months to two-and-a-half months. The number of glaucoma surgeries also increased. SHARING IDEAS She noted that many centres have mobilised in this way to improve the efficiency of glaucoma care. In addition, several members of the World Association of Eye Hospitals (WAEH) convened to compare their approaches. Their analysis revealed many similarities and many differences in their approaches. However, based on the evidence, they reached a consensus that the availability of specific training is really crucial to success. The sharing of ideas and experience should also be continuous, Dr Stalmans said. Ingeborg Stalmans: 
ingeborg.stalmans@mac.com