Shared Cared for Stable Glaucoma Patients
Economic Benefits and Patient-centered Outcomes of a Feasibility Trial
Purpose: The purpose of this article is to assess the quality of care and economic benefits of a shared care model managing patients with stable glaucoma in a primary eye care (PEC) clinic compared with a tertiary specialist outpatient clinic (SOC) in Singapore.
Patients and Methods: A randomized equivalence feasibility trial was preformed comparing the PEC with SOC models. Participants recruited from the SOC had no visual field progression or change in management for at least 3 years, were on a maximum of a single glaucoma medication, had no previous tube-shunt implant and were at least 3-year posttrabeculectomy surgery. Primary outcomes were clinical assessment and management, economic benefits, and patient satisfaction. Differences were analyzed using equivalence testing and generalized odds ratios.
Results: The trial included 233 patients, consisting of 42.1% glaucoma disc suspects, 27.5% primary angle closure suspects, 13.7% with ocular hypertension, 3.9% with primary angle closure glaucoma (PEC: 4.3%; SOC: 3.4%), and 3.0% with primary open angle glaucoma and management. In 23 cases, 5.2% at PEC and 14.5% at SOC, there was disconcordance with the gold standard of senior consultant. Patient satisfaction at the PEC was equally high when compared with SOC. Direct costs per patient visit were 43% lower at PEC compared with SOC.
Conclusion: Managing stable glaucoma patients at a primary care setting is a cost saving, safe, and effective shared care while enhancing professional collaboration between hospital and community settings.
|shared care, task substitution, glaucoma, Singapore|
David Goh, de Korne, D.F, Henrietta Ho, Ranjana Mathur, Bibhas Chakraborty, Nguyen Van Hai, … Lamoureux, E.L. (2018). Shared Cared for Stable Glaucoma Patients. doi:10.1097/IJG.0000000000000852