title: Shared Care in Monitoring Stable Glaucoma Patients: A Randomized Controlled Trial.
abstract: OBJECTIVE
  Comparing the quality of care provided by a hospital-based shared care glaucoma follow-up unit with care as usual.
  
  
  METHODS
  This randomized controlled trial included stable glaucoma patients and patients at risk for developing glaucoma. Patients in the Usual Care group (n=410) were seen by glaucoma specialists. In the glaucoma follow-up unit group (n=405), patients visited the glaucoma follow-up unit twice followed by a visit to a glaucoma specialist. The main outcome measures were: compliance to the working protocol by glaucoma follow-up unit employees; difference in intraocular pressure between baseline and at ≥18 months; and patient satisfaction.
  
  
  RESULTS
  Glaucoma follow-up unit employees closely adhered to the working protocol for the measurement of intraocular pressure, visual acuity and GDx (≥97.5% of all visits). Humphrey Field Analyzer examinations were not performed as frequently as prescribed by the working protocol, but more often than in the Usual Care group. In a small minority of patients that required back-referral, the protocol was disregarded, notably when criteria were only slightly exceeded. There was no statistically significant difference in changes in intraocular pressure between the 2 treatment groups (P=0.854). Patients were slightly more satisfied with the glaucoma follow-up unit employees than with the glaucoma specialists (scores: 8.56 vs. 8.40; P=0.006).
  
  
  CONCLUSIONS
  In general, the hospital-based shared care glaucoma follow-up closely observed its working protocol and patients preferred it slightly over the usual care provided by medical doctors. The glaucoma follow-up unit operated satisfactorily and might serve as a model for shared care strategies elsewhere.
authors.affiliation: *Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam †Rotterdam Ophthalmic Institute, Rotterdam Eye Hospital, Rotterdam §Department of Social Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands ‡School of Public Health, KULeuven, University of Leuven, Leuven, Belgium.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Holtzer-Goor
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: van Vliet
authors.forename: Esther
authors.initials: E
authors.lastname: van Sprundel
authors.forename: Thomas
authors.initials: T
authors.lastname: Plochg
authors.forename: Marc A
authors.initials: MA
authors.lastname: Koopmanschap
authors.forename: Niek S
authors.initials: NS
authors.lastname: Klazinga
authors.forename: Hans G
authors.initials: HG
authors.lastname: Lemij
mesh_terms: D000368:Aged; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009881:Ophthalmic Assistants / Q000458:organization & administration / Q000592:standards; D009885:Ophthalmology / Q000458:organization & administration / Q000592:standards; D009907:Optometry / Q000458:organization & administration / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care / Q000592:standards*; D014065:Tonometry, Ocular; D014792:Visual Acuity