title: A Mixed-Methods Evaluation of a Community-Based Glaucoma Check Service in Hackney, London, UK.
abstract: To evaluate the uptake, feasibility and acceptability of a general practice-based optometrist-led glaucoma check service. The service targeted people of black Caribbean and black African descent aged 40-65 years, resident in Hackney, London, United Kingdom.
  
  
  
  The study used a mixed-method design, including analysis of service data, prospective audit of secondary care referrals patient survey, cost-consequence analysis, and interviews with staff involved in developing and implementing the service.
  
  
  
  A total of 3040 patients were invited to undergo the free check; 595 (19.6%) booked an appointment and 461 (15.2%) attended. Overall, 31 patients (6.8%) were referred to secondary care, of whom 22 attended and were assessed for glaucoma. Four were diagnosed with glaucoma and eight with suspected glaucoma, i.e. 2.6% of patients who underwent the check. The cost per patient identified with suspected or confirmed glaucoma was £9,013. Staff who were interviewed suggested that patients who attended might be those who routinely attended optometrist appointments, however only 62.4% of survey respondents reported having had an eye examination in the previous two years, and 11.4% of women and 16.0% of men reported never having had an eye examination.
  
  
  
  This study represents one possible configuration for a glaucoma case-finding service, and it contributes to a wider debate about whether screening, targeted or otherwise, should be offered in the UK. Our findings suggest that general practice is an acceptable setting and that such a service may reach some people not previously engaged with primary eye care services.
authors.affiliation: a London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holdsworth
authors.affiliation: a London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Datta
authors.affiliation: a London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Dalya
authors.initials: D
authors.lastname: Marks
authors.affiliation: a London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
authors.affiliation: b RNIB , London , UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Lee
authors.affiliation: b RNIB , London , UK.
authors.forename: Shaun
authors.initials: S
authors.lastname: Leamon
authors.affiliation: a London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Lindfield
authors.affiliation: a London School of Hygiene & Tropical Medicine , London , UK.|c NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology , London , UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Wormald
authors.affiliation: c NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology , London , UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Clarke
authors.affiliation: c NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology , London , UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elkarmouty
authors.affiliation: a London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Macdowall
mesh_terms: D000328:Adult; D000368:Aged; D054869:Clinical Audit / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012017:Referral and Consultation; D015351:Vision Screening / Q000379:methods*
keywords: Check; evaluation; general practice; glaucoma; mixed methods; screening