%0 Journal Article
%T Improving Patient Access and Reducing Costs for Glaucoma with Integrated Hospital and Community Care: A Case Study from Australia.
%A Ford BK
%A Angell B
%A Liew G
%A White AJR
%A Keay LJ
%J Int J Integr Care
%V 19
%N 4
%D Nov 2019 6
%M 31749669
暂无%R 10.5334/ijic.4642
%X <B>BACKGROUND: </B>Glaucoma, a chronic eye disease requires regular monitoring and treatment to prevent vision-loss. In Australia, most public ophthalmology departments are overburdened. Community Eye Care is a 'collaborative' care model, involving community-based optometrist assessment and 'virtual review' by ophthalmologists to manage low-risk patients. C-EYE-C was implemented at one Australian hospital. This study aims to determine whether C-EYE-C improves access to care and better utilises resources, compared to hospital-based care.<BR><B>METHODS: </B>A clinical and financial audit was conducted to compare access to care and health system costs for hospital care and C-EYE-C. Attendance, wait-time, patient outcomes, and the average cost per encounter were calculated. A weighted kappa assessed agreement between the optometrist and ophthalmologist decisions.<BR><B>RESULTS: </B>There were 503 low-risk referrals, hospital (n = 182) and C-EYE-C (n = 321). C-EYE-C had higher attendance (81.6% vs 68.7%, p = 0.001); and shorter appointment wait-time (89 vs 386 days, p < 0.001). Following C-EYE-C, 57% of patients avoided hospital; with 39% requiring glaucoma management. C-EYE-C costs were 22% less than hospital care. There was substantial agreement between optometrists and ophthalmologist for diagnosis (k = 0.69, CI 0.61-0.76) and management (k = 0.66, CI 0.57-0.74).<BR><B>CONCLUSIONS: </B>C-EYE-C showed higher attendance, and reduced wait-times and health system costs.<BR><B>CONCLUSIONS: </B>Upscale of the C-EYE-C model should be considered to further improve capacity of public eye services in Australia.