title: The Portsmouth-based glaucoma refinement scheme: a role for virtual clinics in the future?
abstract: BACKGROUND
  Glaucoma referrals continue to impart a significant burden on Hospital Eye Services (HES), with a large proportion of these false positives.
  
  
  OBJECTIVE
  To evaluate the Portsmouth glaucoma scheme, utilising virtual clinics, digital technology, and community optometrists to streamline glaucoma referrals.
  
  
  METHODS
  The stages of the patient trail were mapped and, at each step of the process, 100 consecutive patient decisions were identified. The diagnostic outcomes of 50 consecutive patients referred from the refinement scheme to the HES were identified.
  
  
  RESULTS
  A total of 76% of 'glaucoma' referrals were suitable for the refinement scheme. Overall, 94% of disc images were gradeable in the virtual clinic. In all, 11% of patients 'attending' the virtual clinic were accepted into HES, with 89% being discharged for community follow-up. Of referrals accepted into HES, the positive predictive value (glaucoma/ocular hypertension/suspect) was 0.78 vs 0.37 in the predating 'unrefined' scheme (95% CI 0.65-0.87). The scheme has released 1400 clinic slots/year for HES, and has produced a £244 200/year cost saving for Portsmouth Hospitals' Trust.
  
  
  CONCLUSIONS
  The refinement scheme is streamlining referrals and increasing the positive predictive rate in the diagnosis of glaucoma, glaucoma suspect or ocular hypertension. This consultant-led practice-based commissioning scheme, if adopted widely, is likely to incur a significant cost saving while maintaining high quality of care within the NHS.
authors: Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY,, UK. strikha@doctors.org.uk
authors: S
authors: S
authors: Trikha
authors: C
authors: C
authors: Macgregor
authors: M
authors: M
authors: Jeffery
authors: J
authors: J
authors: Kirwan
mesh_terms: D005189:False Positive Reactions; D005901:Glaucoma / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008875:Middle Aged; D009313:National Health Programs; D009798:Ocular Hypertension / Q000145:classification / Q000175:diagnosis; D009885:Ophthalmology; D009898:Optic Disk / Q000473:pathology*; D009907:Optometry / Q000592:standards*; D010044:Outpatient Clinics, Hospital; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D006113:United Kingdom; D014584:User-Computer Interface; D015351:Vision Screening / Q000592:standards*; D058609:Visual Field Tests; D014794:Visual Fields