The burden of acute eye conditions on different healthcare providers: a retrospective population-based study

Abstract

Background: The demand for acute eyecare exponentially outstrips capacity. The public lacks awareness of community eyecare services.

Aim: To quantify the burden of acute eyecare on different healthcare service providers in a national population through prescribing and medicines provision by GPs, optometrists, and pharmacists, and provision of care by accident and emergency (A&E) services. A secondary aim was to characterise some of the drivers of this burden.

Design and setting: A retrospective data-linkage study set in Wales, UK.

Method: Analysis of datasets was undertaken from the Secure Anonymised Information Linkage Databank (GP and A&E), the Eye Health Examination Wales service (optometry), and the Common Ailments Scheme (pharmacy) during 2017-2018.

Results: A total of 173 999 acute eyecare episodes delivered by GPs (168 877 episodes) and A&E services (5122) were identified during the study. This resulted in 65.4 episodes of care per 1000 people per year. GPs prescribed a total of 87 973 653 prescriptions within the general population. Of these, 820 693 were related to acute eyecare, resulting in a prescribing rate of 0.9%. A total of 5122 eye-related and 905 224 general A&E attendances were identified, respectively, resulting in an A&E attendance rate of 0.6%. Optometrists and pharmacists managed 51.8% (116 868) and 0.6% (2635) of all episodes, respectively. Older females and infants of both sexes were more likely to use GP prescribing services, while adolescent and middle-aged males were more likely to visit A&E. GP prescribing burden was driven partially by economic deprivation, access to services, and health score. Season, day of the week, and time of day were predictors of burden in GP and A&E.

Conclusion: Acute eyecare continues to place considerable burden on GP and A&E services in Wales, particularly in urban areas with greater economic deprivation and lower overall health. This is likely to increase with a rapidly ageing population. With ongoing pathway development to better utilise optometry and pharmacy, and improved public awareness, there may be scope to change this trajectory.

Keywords: emergency medicine; eye; general practice; optometry; pharmacy; primary health care.

Figure 1.

Study flowchart and hypotheses. A&E = accident and emergency. SAIL = Secure Anonymised Information Linkage.

Figure 2.

(a–f). GP and A&E dataset showing distribution with age (a–f). The number of male and female individuals in each of seven age groups are shown within (a) the general Wales population, (b) the general Wales population who had a GP prescribing event for any condition during the study period, (c) the general Wales population who used A&E services for any reason during the study period, (d) the study population, (e) the study population who had a GP prescribing event for an acute eye condition during the study period, and (f) the study population who used A&E services for an eye-related injury during the study period. The age groupings are based on those used by the Welsh Government in the derivation of population estimates (https://statswales.gov.wales). A&E = accident and emergency. WIMD = Welsh Index of Multiple Deprivation. (g–l). GP and A&E dataset showing distribution with Welsh Index of Multiple Deprivation (g–l). The proportion of individuals within each of seven age groups within WIMD quintiles are shown in (g) the general Wales population, (h) the general Wales population who had a GP prescribing event for any condition during the study period, (i) the general Wales population who used A&E services for any reason during the study period, (j) the study population, (k) the study population who had a GP prescribing event for an acute eye condition during the study period, and (l) the study population who used A&E services for an eye-related injury during the study period. The age groupings are based on those used by the Welsh Government in the derivation of population estimates (https://statswales.gov.wales). A&E = accident and emergency. WIMD = Welsh Index of Multiple Deprivation.

Figure 2.

(a–f). GP and A&E dataset showing distribution with age (a–f). The number of male and female individuals in each of seven age groups are shown within (a) the general Wales population, (b) the general Wales population who had a GP prescribing event for any condition during the study period, (c) the general Wales population who used A&E services for any reason during the study period, (d) the study population, (e) the study population who had a GP prescribing event for an acute eye condition during the study period, and (f) the study population who used A&E services for an eye-related injury during the study period. The age groupings are based on those used by the Welsh Government in the derivation of population estimates (https://statswales.gov.wales). A&E = accident and emergency. WIMD = Welsh Index of Multiple Deprivation. (g–l). GP and A&E dataset showing distribution with Welsh Index of Multiple Deprivation (g–l). The proportion of individuals within each of seven age groups within WIMD quintiles are shown in (g) the general Wales population, (h) the general Wales population who had a GP prescribing event for any condition during the study period, (i) the general Wales population who used A&E services for any reason during the study period, (j) the study population, (k) the study population who had a GP prescribing event for an acute eye condition during the study period, and (l) the study population who used A&E services for an eye-related injury during the study period. The age groupings are based on those used by the Welsh Government in the derivation of population estimates (https://statswales.gov.wales). A&E = accident and emergency. WIMD = Welsh Index of Multiple Deprivation.

Figure 3.

Optometry and pharmacy data. Eye Health Examination Wales (optometry) audit data for the study period showing (a) the number of individuals in each of seven age groups, (b) the proportion of symptoms recorded per age group by symptom type, and (c) the proportion of items issued per age group by drug type. The Common Ailments Scheme (pharmacy) audit data for the study period showing (d) the number of male and female individuals in each of seven age groups and (e) the proportion of items issued per age group by drug type. The presented categorisations of symptoms and type of drug are consistent with those reported in the audit data for the given service, and therefore differ between services.

Figure 4.

Burden of acute eyecare conditions over time and effect of predictor variables. Burden of acute eyecare conditions on (a) GP prescribing services by weekday classified by drug type, (b) GP prescribing services by season classified by drug type, (c) A&E services by weekday classified by diagnosis type, (d) A&E services by whether the event took place out of hours (outside of 6 a.m.–6 p.m. Monday–Friday) or not. To prevent the disclosure of identifying information, physical and ‘other’ treatments have been removed from (a) and allergy diagnoses have been removed from (c) and (d). Effect sizes of demographic and socioeconomic predictor variables on episode burden of acute eye conditions, measured as the number of prescriptions issued, calculated through quasi-Poisson GLM. Exp(est) = exponentiated Poisson regression coefficient (β) indicating the unit change in the outcome (number of prescriptions) with each unit or level change in each predictor, should all other predictors be held constant (e). Error bars in (e) show the 95% confidence intervals. WIMD levels 2–5 = Welsh Index of Multiple Deprivation quintiles contrasted against the most deprived areas (level 1); chronic conditions = rate of chronic conditions measured within the WIMD; limiting illness = rate of limiting illnesses measured within the WIMD; ATS levels 2–5 = Access to Services domain quintiles contrasted against the most deprived areas (level 1). The presented categorisations of drug and diagnosis type are consistent with those reported in the audit data for the given service, and therefore differ between services. A&E = accident and emergency. ATS = access to services. GLM = generalised linear model.