PT  - JOURNAL ARTICLE
AU  - Heathcote R Wright
AU  - Jeremy P Diamond
TI  - Service innovation in glaucoma management: using a web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme
AID  - 10.1136/bjophthalmol-2014-305588
DP  - 2015 Mar 01
TA  - British Journal of Ophthalmology
PG  - 313--317
VI  - 99
IP  - 3
4099  - http://bjo.bmj.com/content/99/3/313.short
4100  - http://bjo.bmj.com/content/99/3/313.full
SO  - Br J Ophthalmol2015 Mar 01; 99
AB  - Aim To assess the importance of specialist supervision in a new model of glaucoma service delivery. Methods An optometrist supported by three technicians managed each glaucoma clinic. Patients underwent testing and clinical examination before the optometrist triaged them into one of five groups: ‘normal’, ‘stable’, ‘low risk’, ‘unstable’ and ‘high risk’. Patient data were uploaded to an electronic medical record to facilitate virtual review by a glaucoma specialist. Results 24 257 glaucoma reviews at three glaucoma clinics during a 31-month period were analysed. The clinic optometrists and glaucoma specialists had substantial agreement (κ 0.69). 13 patients were identified to be high risk by the glaucoma specialist that had not been identified as such by the optometrist. Glaucoma specialists amended 13% of the optometrists’ interim decisions resulting in an overall reduction in review appointments by 2.4%. Conclusions Employing technicians and optometrists to triage glaucoma patients into groups defined by risk of blindness allows higher risk patients to be directed to a glaucoma specialist. Virtual review allows the glaucoma specialist to remain in overall control while reducing the risk that patients are treated or followed-up unnecessarily. Demand for glaucoma appointments can be reduced allowing scarce medical resources to be directed to patients most in need.