Collaborative eye care sees treatment efficiencies lead to cost savings
Collaborative care for common eye conditions not only saves money but helps prioritise specialist access for those in more urgent need, according to data presented at the 11th Health Services and Policy Research conference in Auckland today.
The C-EYE-C (community eye care) model of care, implemented at Westmead hospital with support from the NSW Agency for Clinical Innovation, streamlines access to ophthalmology services through an innovative partnership between local optometrists and hospital ophthalmologists.
Belinda Ford, PhD Candidate at The George Institute for Global Health said that while this model had already shown beneficial outcomes in low risk glaucoma patients, it was now clear that that these benefits could be extended to diabetic retinopathy.
“Our study of 133 patients with low risk diabetic retinopathy found that two-thirds (68 percent) of those referred via the C-EYE-C pathway were able to avoid a hospital appointment, whereas through the standard hospital pathway all of these patients would have required one,” she said.
A referral from a primary care provider is required for a patient to access specialist eye care at a tertiary hospital, however, without being able to triage these referrals there can be long waits for those who need urgent care and unnecessary referrals for those who don’t.
Patients attending C-EYE-C received standard assessment and imaging with an optometrist in a community setting and all patients had access to an ophthalmologist via a virtual review clinic where assessment and imaging was reviewed to confirm diagnosis and management. Those requiring ophthalmologist specialist intervention or management were streamlined into hospital appointments, avoiding further appointment wait-times.
“With this new model of care, we saw waiting times for ophthalmologist review reduced from the usual four months to less than two months. It also led to cost savings of 43 percent, so it’s a win-win for both patients and the health service,” added Ms Ford.
Diabetic retinopathy (DR) is a complication of diabetes, caused by microvascular changes to the retina and is one of the leading causes of vision loss and blindness. An estimated 35 percent of people with DM will have DR and around 10 percent of people with DM will have vision-threatening levels of DR.
People with DR are recommended to undergo retinal screening every two years, including retinal photography, and need timely access to treatments.
“There is a large demand for hospital services for chronic eye diseases like diabetic eye disease and glaucoma - we have seen average waiting times of 400 days from referral for glaucoma to access necessary sight saving interventions and 139 days for diabetic retinopathy, which is very concerning,” added Ms Ford.
Clinical Associate Professor Andrew White, Head of Ophthalmology at Westmead, said that there was clearly a strong need to better communicate information from community providers to public hospitals to make more efficient use of already overstretched specialist services.
“These models are well established in other countries like the UK but the uptake has been slow in Australia with only a few schemes running in New South Wales and Victoria. Now we have demonstrated the cost and efficiency savings, and also published this as a model of care, its time for other centres to make integrated care a priority,” he said.
The Westmead C-EYE-C scheme continues to be delivered through Joe Nazarian, a community optometrist in Blacktown, NSW, and will continue in 2020 through a new clinic established with the Centre for Eye Health in Parramatta.
Ford BK, et al. Improving Patient Access and Reducing Costs for Glaucoma with Integrated Hospital and Community Care: A Case Study from Australia. Int J of Integrated Care 2019;19(4):5
Duri K, et al. Glaucoma referrals to a tertiary care glaucoma service in Australia. Clin & Experimental Opthalmology 2019;47(8):1092