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Evaluating and optimising glaucoma referral refinement pathways with specific reference to the changes scheme

Ratnarajan, G; (2016) Evaluating and optimising glaucoma referral refinement pathways with specific reference to the changes scheme. Doctoral thesis , UCL (University College London). Green open access

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Abstract

Background: The Hospital Eye Service (HES) was receiving an unsustainable level of new referrals for suspected glaucoma, which was resulting in delays in clinic appointments. In an attempt to reduce the burden on the HES the concept of refining a referral from the high street optometrist was introduced. Glaucoma Referral Refinement schemes (GRRS) have proliferated across the country over the past decade, often demonstrating marked variation in pathway design, referral criteria as well as the level of specialist optometrist competency and training. Standardisation of GRRS through national policy is required. / Plan of Research: The investigations are focused around 6 parts. The first three parts address referral criteria of GRRS and the agreement between eye health professionals through a multi-site review of schemes in England. The next two parts look at the experience of care and the access to eye health in a GRRS. The last section builds upon the findings from the first three parts and focuses on safety and in particular the role of virtual review in these schemes. / Results: Specialist optometrists working within GRRS can reduce the proportion of patients discharged at the first visit in the HES. However overemphasis on intra-ocular pressure as a criterion for referral is having an adverse effect on detection of glaucomatous optic nerve features. Low-risk referrals are suitable for specialist optometrist review, with virtual review an effective extra safety measure. High-risk referrals should be reviewed directly in the HES. / Clinical Significance: GRRS is a safe and cost effective method of reviewing low-risk glaucoma referrals. This research can contribute evidence to help establish a national policy for both the referral criteria and the organisational set-up of GRRS in the UK.

Type: Thesis (Doctoral)
Title: Evaluating and optimising glaucoma referral refinement pathways with specific reference to the changes scheme
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/1507860
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