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. 2012 Oct;26(10):1288-94.
doi: 10.1038/eye.2012.120. Epub 2012 Jul 6.

The Portsmouth-based glaucoma refinement scheme: a role for virtual clinics in the future?

S Trikha  1 , C Macgregor, M Jeffery, J Kirwan
Affiliations

The Portsmouth-based glaucoma refinement scheme: a role for virtual clinics in the future?

S Trikha et al. Eye (Lond). 2012 Oct.

Abstract

Background: Glaucoma referrals continue to impart a significant burden on Hospital Eye Services (HES), with a large proportion of these false positives.

Aims: To evaluate the Portsmouth glaucoma scheme, utilising virtual clinics, digital technology, and community optometrists to streamline glaucoma referrals.

Method: The stages of the patient trail were mapped and, at each step of the process, 100 consecutive patient decisions were identified. The diagnostic outcomes of 50 consecutive patients referred from the refinement scheme to the HES were identified.

Results: A total of 76% of 'glaucoma' referrals were suitable for the refinement scheme. Overall, 94% of disc images were gradeable in the virtual clinic. In all, 11% of patients 'attending' the virtual clinic were accepted into HES, with 89% being discharged for community follow-up. Of referrals accepted into HES, the positive predictive value (glaucoma/ocular hypertension/suspect) was 0.78 vs 0.37 in the predating 'unrefined' scheme (95% CI 0.65-0.87). The scheme has released 1400 clinic slots/year for HES, and has produced a £244 200/year cost saving for Portsmouth Hospitals' Trust.

Conclusion: The refinement scheme is streamlining referrals and increasing the positive predictive rate in the diagnosis of glaucoma, glaucoma suspect or ocular hypertension. This consultant-led practice-based commissioning scheme, if adopted widely, is likely to incur a significant cost saving while maintaining high quality of care within the NHS.

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Figures

Figure 1
Figure 1
Outline of the refinement scheme.
Figure 2
Figure 2
The refinement scheme audit process.
Figure 3
Figure 3
(a) The grading system of optic disc images. (b) Outcomes of initial referrals by community optometrists. (c) Optic disc grading in the virtual clinic. (d) Assessment of disc images in the virtual clinic. (e) The outcome of virtual clinic ‘appointments'. (f) A bar graph to illustrate the outcome of virtual clinic ‘appointments'. (g) The outcome of the HES appointments of patients referred through the refinement scheme.
Figure 4
Figure 4
A comparison between ‘refined' and ‘unrefined' schemes. PPR=(diagnosis of glaucoma or OHT/total number referred).
See this image and copyright information in PMC

Comment in

References

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