title: Community refinement of glaucoma referrals.
abstract: OBJECTIVE
  To describe a Manchester-based glaucoma referral refinement scheme designed to reduce the number of false-positive referrals to the hospital eye service. To report on the first years results of this scheme and its financial costs to the NHS.
  
  
  METHODS
  Patients with suspected glaucoma, instead of being referred to their GP and then on to the hospital eye service, were referred to a group of specially trained community optometrists working to an agreed set of referral criteria. Those patients who did not meet the referral criteria were returned to the referring optometrist, while those who met the referral criteria were referred directly to Manchester Royal Eye Hospital. The patient's GP was informed in all cases.
  
  
  RESULTS
  The number of suspect glaucoma cases referred to the Manchester Royal Eye Hospital was reduced by 40%. This figure is close to the percentage of false-positive referrals measured at Manchester Royal Eye Hospital prior to the onset of this study. The information accompanying referral has been improved and the scheme produces a small financial cost saving to the NHS of approximately 17 pounds sterling per patient.
  
  
  CONCLUSIONS
  Community refinement of suspect glaucoma offers some important benefits over the current referral pathway.
authors.affiliation: Academic Department of Ophthamology, Manchester University and Manchester Royal Eye Hospital, UK. david.henson@man.ac.uk
authors.forename: D B
authors.initials: DB
authors.lastname: Henson
authors.forename: A F
authors.initials: AF
authors.lastname: Spencer
authors.forename: R
authors.initials: R
authors.lastname: Harper
authors.forename: E J
authors.initials: EJ
authors.lastname: Cadman
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D004739:England; D005189:False Positive Reactions; D005901:Glaucoma / Q000175:diagnosis* / Q000191:economics; D017048:Health Care Costs; D006782:Hospitals, Special; D006801:Humans; D009885:Ophthalmology; D009907:Optometry / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D013222:State Medicine / Q000191:economics / Q000458:organization & administration; D015351:Vision Screening / Q000191:economics / Q000458:organization & administration / Q000592:standards*