title: A comparative study of glaucoma referrals in Southeast Scotland: effect of the new general ophthalmic service contract, Eyecare integration pilot programme and NICE guidelines.
abstract: BACKGROUND
  Glaucoma is a progressive disease responsible for the second commonest cause of blindness in the UK. Identifying appropriate patients for hospital care remains an ongoing challenge for all UK hospital glaucoma services. The purpose of our study is to evaluate accuracy and outcome of community optometry referrals before and after implementation of the new general ophthalmic service contract in 2006, the Eyecare Integration Programme pilot in 2008 and the effect of NICE guidelines in glaucoma in 2009, over a 12-year period
  
  
  METHODS
  A retrospective case analysis using a glaucoma electronic patient record was performed encompassing two six-year periods, 2000-2006 (Group A), and 2007-2012 (Group B).
  
  
  RESULTS
  One thousand six hundred twenty-two new patients' records were analysed. Waiting times reduced from 12.3 to 9.4 weeks. Significantly more patients kept first appointment (p = 0.0002) in group B. Glaucoma symptoms were significantly more in group A (p <0.0001) and only three patients lost Snellen' visual acuity before appointment in group B compared to 12 in group A. Documentation of intraocular pressure was made in 74.1% of Group A and 75.9% of Group B, optic disc appearance in 85.4% of Group A, and 93% of Group B and visual fields in 84.4% of Group A and 81.3% of Group B. Significantly less normal (p < 0,0001), more glaucoma suspects (p < 0.0001), more open angle glaucoma (p = 0.0006) and fewer other conditions (p = 0.0024) were present in group B, compared to group A.
  
  
  CONCLUSIONS
  Patients were referred earlier with shorter waiting times for hospital appointments with the new Scottish general ophthalmic service and Eyecare Integration Programme. Additionally there were fewer false positive referrals with more diagnosis of glaucomatous disease. We discuss the benefits of these national screening and referral pathways together with their limitations and further refinements.
authors.affiliation: Department of Ophthalmology, Queen Margaret Hospital, Whitefield Road, KY12 0SU, Dunfermline, Fife, UK. karim.el-assal@nhs.net.
authors.forename: Karim
authors.initials: K
authors.lastname: El-Assal
authors.affiliation: Department of Ophthalmology, Ninewells Hospital, Dundee, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Foulds
authors.affiliation: Medical Informatics, Queen Margaret Hospital, Dunfermline, Fife, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Dobson
authors.affiliation: Department of Ophthalmology, Queen Margaret Hospital, Whitefield Road, KY12 0SU, Dunfermline, Fife, UK.
authors.forename: Roshini
authors.initials: R
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032982:Contracts; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004282:Documentation / Q000706:statistics & numerical data; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000453:epidemiology; D019983:Guideline Adherence; D006748:Hospital Departments / Q000592:standards*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration / Q000592:standards*; D009885:Ophthalmology / Q000592:standards; D009887:Ophthalmoscopy; D009907:Optometry / Q000592:standards*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic / Q000592:standards*; D012017:Referral and Consultation / Q000458:organization & administration / Q000592:standards*; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D014065:Tonometry, Ocular; D058609:Visual Field Tests; D014794:Visual Fields; D014850:Waiting Lists