GLAUCOMA UPDATE Royal College Guidelines for Ocular ：青光眼眼皇家学院指南更新.ppt

New Care Pathways in Glaucoma Stephen A. Vernon DM FRCS FRCOphth DO Factors driving change in glaucoma Elderly population increasing More cases detected (esp NTG) Low ratio of ophthalmol. : patients in UK Increasing specialisation and investigations Changes in training reduces clinic staff Drive for low target pressures – more visits Medical management options greater - more visits Demand for “patient centred care” – patient choice, CB New targets for first OPD visits lead to bow-wave of follow up patients Desire of PCT to save money Payment by results The Optometrists lobby. Demographic details of presenting patients Past (1980) 63% via optometrists Mean age 70.6 Mean IOP 31.7mmHg 33% late 10% reg blind few false positives Demographic details of presenting patients Present 98% via optometrists Mean age reducing Mean IOP reducing fewer present late rare to register blind at presentation false positive referrals a problem Workload calculation for UK ophthalmologists 380,000 glaucoma patients in UK 540 patients per consultant Average 2.5 visits/yr 1600 visits/yr 3 clinics available 533 visits per clinic for 42 weeks 13 glaucoma pts/clinic (if all diagnosed) Workload calculation for UK ophthalmologists 13 glaucoma pts/clinic (if all diagnosed) 50% diagnosed But 200 suspect referrals/yr + review suspects/OHT 6 per clinic 12.5 glaucoma related patients every clinic If all consultants “do” glaucoma Glaucoma accounts for only 25% of OPD visits The current “English” care pathway Suspects “detected” by optometrists Referred to GP by letter (GOS18) GP sends letter + GOS18? to patient choice co-ordinating centre Patient rings centre to choose secondary provider Choice centre sends letter to secondary provider Letter vetted by ophthalmologist Patient sent appointment(s) for clinic CaB is changing this Diagnosis glaucoma, suspect or normal (1/3 each) HES manages glaucomas and most suspects But ………….. Membership of DoH Work