title: Health professionals' and service users' perspectives of shared care for monitoring wet age-related macular degeneration: a qualitative study alongside the ECHoES trial.
abstract: OBJECTIVE
  To explore the views of eye health professionals and service users on shared community and hospital care for wet or neovascular age-related macular degeneration (nAMD).
  
  
  METHODS
  Using maximum variation sampling, 5 focus groups and 10 interviews were conducted with 23 service users and 24 eye health professionals from across the UK (consisting of 8 optometrists, 6 ophthalmologists, 6 commissioners, 2 public health representatives and 2 clinical eye care advisors to local Clinical Commissioning Groups). Data were transcribed verbatim and analysed thematically using constant comparative techniques derived from grounded theory methodology.
  
  
  RESULTS
  The needs and preferences of those with nAMD appear to be at odds with the current service being provided. There was enthusiasm among health professionals and service users about the possibility of shared care for nAMD as it was felt to have the potential to relieve hospital eye service burden and represent a more patient-centred option, but there were a number of perceived barriers to implementation. Some service users and ophthalmologists voiced concerns about optometrist competency and the potential for delays with referrals to secondary care if stable nAMD became active again. The health professionals were divided as to whether shared care was financially more efficient than the current model of care. Specialist training for optometrists, under the supervision of ophthalmologists, was deemed to be the most effective method of training and was perceived to have the potential to improve the communication and trust that shared care would require.
  
  
  CONCLUSIONS
  While shared care is perceived to represent a promising model of nAMD care, voiced concerns suggest that there would need to be greater collaboration between ophthalmology and optometry, in terms of interprofessional trust and communication.
  
  
  BACKGROUND
  ISRCTN07479761.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: Townsend
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK.
authors.forename: B C
authors.initials: BC
authors.lastname: Reeves
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK.
authors.forename: U
authors.initials: U
authors.lastname: Chakravarthy
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast, UK.
authors.forename: D
authors.initials: D
authors.lastname: O'Reilly
authors.affiliation: Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Hogg
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: N
authors.initials: N
authors.lastname: Mills
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009907:Optometry / Q000458:organization & administration*; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D036301:Qualitative Research; D006113:United Kingdom; D057135:Wet Macular Degeneration / Q000628:therapy*
keywords: OPHTHALMOLOGY; QUALITATIVE RESEARCH