Shared Care in Monitoring Stable Glaucoma Patients: A Randomized Controlled Trial

Kim M Holtzer-Goor, Ellen J van Vliet, Esther van Sprundel, Thomas Plochg, Marc A Koopmanschap, Niek S Klazinga, Hans G Lemij

Research output: Contribution to journalArticleResearchpeer-review

Abstract

PURPOSE: Comparing the quality of care provided by a hospital-based shared care glaucoma follow-up unit with care as usual.

PATIENTS AND 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.

Original languageEnglish
Pages (from-to)e392-400
JournalJournal of Glaucoma
Volume25
Issue number4
DOIs
Publication statusPublished - Apr 2016

Keywords

  • Aged
  • Female
  • Glaucoma/physiopathology
  • Humans
  • Intraocular Pressure/physiology
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Ophthalmic Assistants/organization & administration
  • Ophthalmology/organization & administration
  • Optometry/organization & administration
  • Patient Care Team/organization & administration
  • Patient Satisfaction
  • Patient-Centered Care
  • Quality Assurance, Health Care
  • Quality of Health Care/standards
  • Tonometry, Ocular
  • Visual Acuity

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