research
Monitoring of stable glaucoma patients
- Publication date
- 1 January 2010
- Publisher
- 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 ba