Real-world outcomes of allied health professional-led clinic model for assessing and monitoring ocular melanocytic lesions

Abstract

Background: Naevomelanocytic lesions comprise an increasing workload in ophthalmic secondary care and, although largely benign, carry high risk of mortality in case of malignant transformation. Previous studies highlight the theoretical strength of virtual models in monitoring such lesions and the role of allied health professionals (AHPs). We aim to describe and validate a "real-world" functional clinical model utilising these particular resources.

Methods: New and existing follow-up patients from November 2016 to June 2019 with melanocytic lesions of the uveal tract and conjunctiva were directed into an optometrist-led, consultant-supported, clinic. Diagnostic tests included colour photography, autofluorescence, enhanced-depth imaging and ultrasound biomicroscopy. New patients were examined face-to-face initially, then virtually on subsequent visits. Suspicious lesions were referred to the consultant, with tertiary oncology referrals made as necessary. Clinical concordance between optometrist and consultant, patient satisfaction and outcomes of second opinion requests were audited.

Results: Eight hundred and twenty-five patient episodes were encountered: 419 new and 406 follow-up. Between July 1st and August 31st 2018, 72 cases were audited. There was 98.6% concordance between AHP and consultant for diagnosis and management. Referral for consultant second opinion was requested in 18(2%) clinical encounters, with 4(0.5%) referred on to the oncology centre, of which 3 received treatment. Of 65 patients responding to a patient satisfaction survey, 100% were satisfied with their experience and 95% were happy to continue monitoring by the AHP.

Conclusion: With robust training and assessment, AHP-led service models are a highly efficient in busy units, without compromising patient safety.

Fig. 1. Flowchart detailing patient flow through clinic.

All patients enter the AHP-led arm (left side) of the pathway with a face-to-face assessment in the first instance, with subsequent follow-up in the same arm if suitable. Patients are referred into the concultant-led arm (right side) of the pathway if there are suspicious features which may require intervention. Patients can be migrated from one side to the other depending on need.

Fig. 2. Outcomes of referrals to consultant for second opinion.

Patients referred into the consultant clinic may be referred back to the AHP clinic after consultant review, have continued consultant follow-up if there are suspicious features (detailed in the figure) or be referred on for tertiary input (detailed in the figure).