4 research outputs found
Monitoring of stable glaucoma patients
A high workload for ophthalmologists and long waiting lists for patients challenge the
organization of ophthalmic care. Tasks that require less specialized skills, like the
monitoring of stable (well controlled) glaucoma patients could be substituted from
ophthalmologists to other professionals (substitution in person). In addition, care
could perhaps be provided in an ambulatory setting (substitution in location of care).
To date, little is known about substituting care in ophthalmology, the organizational
and professional dynamics involved and any consequences for both the quality of
care and cost effectiveness.
Glaucoma is the name given to a group of eye diseases characterized by damage to
the optic nerve yielding gradual, irreversible loss of visual field. Glaucoma is often
related to too high an intraocular pressure (IOP) and is age related. The usual care
for glaucoma patients consists of diagnosis, lifelong monitoring, and treatment and is
provided by ophthalmologists. However, monitoring stable glaucoma patients will
presumably not require the specialist expertise of an ophthalmologist and may be
carried out by less specialized professionals. Therefore, the quality of care given to
stable glaucoma patients was evaluated when provided by ophthalmic technicians or
optometrists based on pre-set protocols and under supervision of ophthalmologists in
a Glaucoma follow-up unit (GFU) within The Rotterdam Eye Hospital (REH).
The objective of this study is to evaluate an organizational intervention, a GFU for
monitoring stable glaucoma patients in a hospital setting, staffed by non-physician
Health Care Professionals instead of ophthalmologists. Furthermore, conditions will
be formulated that need to be fulfilled to successfully substitute the monitoring care
for stable glaucoma patients to a primary care optometrist (substitution in person as
well as in location). The conditions will be b
Creating patient value in glaucoma care
Purpose: The purpose of this paper is to explore in a specific hospital care process the applicability
in practice of the theories of quality costing and value chains.
Design/methodology/approach: In a retrospective case study an in-depth evaluation of the use of
a quality cost mode
Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: A qualitative study
Background: Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders' perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists.Methods: A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis.Results: Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based gl
Adjuvant hyperthermic intraperitoneal chemotherapy in patients with locally advanced colon cancer (COLOPEC): a multicentre, open-label, randomised trial
Background: Nearly a quarter of patients with locally advanced (T4 stage) or perforated colon cancer are at risk of developing peritoneal metastases, often without curative treatment options. We aimed to determine the efficacy of adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with locally advanced colon cancer. Methods: This multicentre, open-label trial was done in nine hospitals that specialised in HIPEC in the Netherlands. Patients with clinical or pathological T4N0–2M0-stage tumours or perforated colon cancer were randomly assigned (1:1), with a web-based randomisation application, before resection of the primary tumour, to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy (experimental group) or to adjuvant systemic chemotherapy alone (control group). Patients were stratified by tumour characteristic (T4 or perforation), age (<65 years or ≥65 years), and surgical approach of the primary tumour resection (laparoscopic or open). Key eligibility criteria included age between 18 and 75 years, adequate clinical condition for HIPEC, and intention to start adjuvant systemic chemotherapy. Patients with metastatic disease were ineligible. Adjuvant HIPEC consisted of fluorouracil (400 mg/m2) and leucovorin (20 mg/m2) delivered intravenously followed by intraperitoneal delivery of oxaliplatin (460 mg/m2) for 30 min at 42°C, delivered simultaneously or within 5–8 weeks after primary tumour resection. In all patients without evidence of recurrent disease at 18 months, a diagnostic laparoscopy was done. The primary endpoint was peritoneal metastasis free-survival at 18 months, measured in the intention-to-treat population, with the Kaplan-Meier method. Adverse events were assessed in all patients who received assigned treatment. This study is registered with ClinicalTrials.gov, number NCT02231086. Findings: Between April 1, 2015, and Feb 20, 2017, 204 patients were randomly assigned to treatment (102 in each group). In the HIPEC group, two patients withdrew consent after randomisation. In this group, 19 (19%) of 100 patients were diagnosed with peritoneal metastases: nine (47%) during surgical exploration preceding intentional adjuvant HIPEC, eight (42%) during routine follow-up, and two (11%) during diagnostic laparoscopy at 18-months. In the control group, 23 (23%) of 102 patients were diagnosed with peritoneal metastases, of whom seven (30%) were diagnosed by laparoscopy at 18-months and 16 during regular follow-up (therefore making them ineligible for diagnostic laparoscopy). In the intention-to-treat analysis (n=202), there was no difference in peritoneal-free survival at 18-months (80·9% [95% CI 73·3–88·5] for the experimental group vs 76·2% [68·0–84·4] for the control group, log-rank one-sided p=0·28). 12 (14%) of 87 patients who received adjuvant HIPEC developed postoperative complications and one (1%) encapsulating peritoneal sclerosis. Interpretation: In patients with T4 or perforated colon cancer, treatment with adjuvant HIPEC with oxaliplatin did not improve peritoneal metastasis-free survival at 18 months. Routine use of adjuvant HIPEC is not advocated on the basis of this trial. Funding: Organization for Health Research and Development and the Dutch Cancer Society