title: An economic comparison of hospital-based and community-based glaucoma clinics.
abstract: BACKGROUND
  We have established one model for community care of glaucoma clinic patients. Community optometrists received training and accreditation in glaucoma care. Once qualified they alternated between running half day glaucoma clinics in their own High Street practices and assisting in a hospital-based glaucoma clinic session. This paper reports the cost of this model.
  
  
  METHODS
  Micro-costing was undertaken for the hospital clinic. A consensus meeting was held to agree costs for community clinics involving all optometrists in the project along with representatives of the multiple chain optometry practices who had participated. Costs to patients both indirect and direct were calculated following structured interviews of 197 patients attending hospital clinics and 194 attending community clinics.
  
  
  RESULTS
  The estimated cost per patient attendance to the hospital clinic was £63.91 and the estimated cost per attendance to the community clinic was £145.62. For patients the combined direct and indirect cost to attend the hospital clinic was £6.15 and the cost to attend the community clinic £5.91.
  
  
  CONCLUSIONS
  The principal reason for the higher cost in the community clinic was higher overhead costs in the community. Re-referral to the hospital system only occurred for 9% of patients and was not a large contribution to the increased cost. Time requested to next appointment was similar for the two clinics. Sensitivity analysis shows a strong effect of increasing patients seen per clinic. It would, however, require 25 patients to be seen per clinician per day in the community in order to make the costs comparable.
authors.affiliation: Department of Genetics, Institute of Ophthalmology, London, UK. anu1478@hotmail.co.uk
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.forename: M
authors.initials: M
authors.lastname: Jofre-Bonet
authors.forename: M
authors.initials: M
authors.lastname: Panca
authors.forename: J G
authors.initials: JG
authors.lastname: Lawrenson
authors.forename: I
authors.initials: I
authors.lastname: Murdoch
mesh_terms: D003153:Community Health Services / Q000191:economics*; D017281:Cost of Illness; D004739:England; D005260:Female; D005901:Glaucoma / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009907:Optometry / Q000191:economics* / Q000193:education; D010044:Outpatient Clinics, Hospital / Q000191:economics*