title: 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).
abstract: 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.
authors: Glaucoma Service, Department of Ophthalmology, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK. rb@rupertbourne.co.uk
authors: R R A
authors: RR
authors: Bourne
authors: K A
authors: KA
authors: French
authors: L
authors: L
authors: Chang
authors: A D
authors: AD
authors: Borman
authors: M
authors: M
authors: Hingorani
authors: W D
authors: WD
authors: Newsom
mesh_terms: 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