title: Patterns of adherence to NICE glaucoma guidance in two different service delivery models.
abstract: OBJECTIVE
  To assess adherence patterns to the UK National Institute of Health and Clinical Excellence (NICE) guidelines on glaucoma management (2009) in a tertiary referral centre shared care setting and in a district general hospital (DGH) setting.
  
  
  METHODS
  We performed a retrospective case note analysis of 200 patients from two centres between January and June 2010. The two centres involved were a consultant-guided teaching hospital optometry-led shared care setting (setting 1) and a consultant-led DGH clinic setting (setting 2). The main outcome measures were compliance with eight of the main NICE guidelines on glaucoma diagnosis and management (2009).
  
  
  RESULTS
  Both centres showed good adherence to the guidelines regarding the choice of initial treatment (96% vs 100%, settings 1 and 2, respectively) and arranging appropriate monitoring intervals (92% vs 86%). However, significant differences were seen when assessing whether an optic disc image was obtained at the initial visit (74% vs 10%), whether an appropriate initial assessment was performed (96% vs 58%), whether patients' review interval complied with the NICE guidance regardless of hospital cancellations (92% vs 66%), and whether concordance with medication was checked (88% vs 24%) (settings 1 and 2, respectively, P<0.01-Fisher's exact test).
  
  
  CONCLUSIONS
  Our study provides evidence to suggest that a hospital-based shared care service with trained optometrists using assessment sheets compares favourably to non-specialist glaucoma care delivered by ophthalmologists.
authors.affiliation: Manchester Royal Eye Hospital and Manchester Academic and Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. anand001@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Chawla
authors.forename: I
authors.initials: I
authors.lastname: Patel
authors.forename: C
authors.initials: C
authors.lastname: Yuen
authors.forename: C
authors.initials: C
authors.lastname: Fenerty
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006068:Gonioscopy; D019983:Guideline Adherence / Q000592:standards*; D006767:Hospitals, District / Q000592:standards; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards; D009885:Ophthalmology / Q000592:standards*; D009907:Optometry / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D006113:United Kingdom; D058609:Visual Field Tests; D014794:Visual Fields