Can a community optometrist-based referral refinement scheme reduce false-positive glaucoma hospital referrals without compromising quality of care? The community and hospital allied network glaucoma evaluation scheme (CHANGES).
OBJECTIVE
To describe the design, activity, and quality of the referral refinement phase of a novel glaucoma shared-care scheme.


METHODS
Eight Optometrists with a Specialist Interest in glaucoma (OSI) were trained to perform a community-based comprehensive glaucoma evaluation of low-risk glaucoma hospital referrals (only one/none of the following factors noted for either eye: abnormal optic disc, abnormal visual field, abnormal intraocular pressure (IOP; 22-28 mmHg or IOP asymmetry)) using equipment standardized to that of the hospital glaucoma service.


RESULTS
One hundred and thirty-eight (27%) of a total of 512 glaucoma-related referrals were deemed 'low risk'. Their choice of OSI discharged 40 (35%). The consultant agreed (virtually) with the decision to discharge with 28 (70%) and disagreed with 12 (30%). Comparing findings between OSI and consultant for 99 referred patients, sensitivity, specificity, and negative predictive values for a suspicious optic disc were 78, 61, and 79%, respectively. For an IOP of >21 mmHg, they were 74, 85, and 90%, respectively. For an occludable anterior chamber angle (Van Herick's versus gonioscopy), they were 69, 88, and 94%, respectively.


CONCLUSIONS
This referral refinement process can reduce numbers of false-positive referrals attending the hospital glaucoma service while retaining a relatively high level of examination quality.
Bourne
R R A
RR
Glaucoma Service, Department of Ophthalmology, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK. rb@rupertbourne.co.uk
French
K A
KA
Chang
L
L
Borman
A D
AD
Hingorani
M
M
Newsom
W D
WD
D003153:Community Health Services / Q000458:organization & administration / Q000592:standards*; D019058:Community Networks / Q000458:organization & administration*; D005901:Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D006764:Hospitals, Community / Q000458:organization & administration; D006801:Humans; D007429:Intraocular Pressure; D009907:Optometry / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards; D012017:Referral and Consultation / Q000458:organization & administration / Q000592:standards*; D012680:Sensitivity and Specificity; D006113:United Kingdom; D015351:Vision Screening / Q000458:organization & administration / Q000592:standards; D014794:Visual Fields