Belinda Ford (Westmead research fellow), Dr Philemon Huang (Westmead glaucoma fellow), Dr Rohan Gupta (Westmead glaucoma fellow) on Community Eye Care (C-Eye-C) Clinic impacting public health care.
If you ask a room full of patients in the public hospital’s eye clinic about their experience, you might hear the same story repeated over and over. The long wait, being shuffled around, doing investigations, waiting again, reviewed by the doctor, waiting again.
You know, it is not too different from a clinician’s perspective. We want to do the best for our patients, to provide them the best care possible, and to give them the best experience possible. But the large patient load can hinder that. We need to focus our expertise on the complex patients with advancing disease, those who need us the most to receive treatments or surgery to prevent them from losing their vision. But we also can’t forget those with lower levels of disease, they need us too. It would be wonderful if we had the time to examine each and every patient, but this is a luxury few can afford.
At Westmead hospital’s ophthalmology department, a new initiative has made it possible to maximise our ophthalmologist’s time and to cover a larger patient load. To make sure our patients are getting the right level of care for their needs, when they need it.
Community Eye Care (C-EYE-C) is a collaborative care initiative that allows improved access to ophthalmology services for patients in Western Sydney, by partnering with local optometrists to conduct standardised examinations, which are then reviewed remotely by hospital ophthalmologists.
It is based on international evidence and suitable for all NSW Health facilities. The referral pathway sends low risk and stable glaucoma and diabetic retinopathy patients to community-based optometrists for assessment. During the appointment, the optometrist completes a standardised eye assessment, including imaging, and recommends a patient management plan.
The files are then transferred electronically to Westmead Hospital for an ophthalmologist’s review. The ophthalmologist confirms the diagnosis and management plan, and either refers the patient back to C-EYE-C for a follow-up review, refers them to Westmead Eye Clinic, or the patient is discharged to their local general practitioner or optometrist. Triage guidelines and referral letters were developed for this project, in addition to formal partnership agreements with private optometrists. (Figure 1 below)
All of this at a 22% lower cost to the public healthcare system. From a patient’s perspective, C-EYE-C has seen a shorter wait-time to access specialist care, for both those with lower levels of need accessing community services (9-months faster), and those with more complex need accessing hospital specialist services (10-weeks faster). Patients also spend substantially less time at C-EYE-C appointments than they would at the hospital, and are more satisfied with clinic access and parking in community locations.
From an ophthalmologist perspective, we are now able to treat and manage our patients with higher clinical needs who need our skills the most; and working with skilled optometrists allows us to oversee the care plans for our patients with lower levels of disease. It’s a win-win!
Check out a short video summarizing what C-Eye-C is all about. https://www.youtube.com/watch?v=gin0KCi0f7E