An audit on the impact of training for a Referral Refinement Scheme in Northern Ireland on community optometrists’ clinical practice when assessing for signs of glaucoma

Research output: Contribution to journalArticle

Abstract

Background: The implementation of NICE Clinical Guideline 85 in 2009 increased the number of ocular hypertensive referrals from optometrists into ophthalmology clinics in Northern Ireland(NI). A local enhanced service (LES) was introduced in 2013 as a repeat IOP measure scheme to reduce false positive referrals. This study is a comparative audit of optometrists’ practice in assessing signs of glaucoma, pre and post training for LES accreditation.Methods: The audit comprised three stages: In stage one 1138 patient records in four community practices were examined for information on optometrists' clinical assessment before and after LES training. In stage two, audited optometrists were surveyed on the impact the training had on their routine clinical practice and stage three surveyed all LES accredited optometrists in NI.Results: The records of the optometrists audited in stage one and the responses from stage two showed an increase in the frequency of assessment of the anterior chamber in patients with a family history of glaucoma and an increase in the use of a contact tonometer if IOPs were found to be >21mmHg, subsequent to training. Responses in stage 3 (n=110) regarding the impact of LES training showed that 63% of practitioners felt that the LES training had improved their clinical assessment for signs of glaucoma, however, respondents highlighted the need for more specific feedback from referrals. Conclusions: The LES had a positive impact on practitioners’ choice of pre-referral assessments performed in primary optometric practice.
LanguageEnglish
Pages27-40
JournalOptometry in Practice
Volume18
Issue number1
Early online date1 Jan 2017
Publication statusPublished - 1 Jan 2017

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Northern Ireland
Glaucoma
Referral and Consultation
Accreditation
Anterior Chamber
Ophthalmology
Optometrists
Guidelines

Keywords

  • Glaucoma
  • optometrist
  • referral
  • community

Cite this

@article{a730b63fbbd542ef8ad3244aae9e5dd0,
title = "An audit on the impact of training for a Referral Refinement Scheme in Northern Ireland on community optometrists’ clinical practice when assessing for signs of glaucoma",
abstract = "Background: The implementation of NICE Clinical Guideline 85 in 2009 increased the number of ocular hypertensive referrals from optometrists into ophthalmology clinics in Northern Ireland(NI). A local enhanced service (LES) was introduced in 2013 as a repeat IOP measure scheme to reduce false positive referrals. This study is a comparative audit of optometrists’ practice in assessing signs of glaucoma, pre and post training for LES accreditation.Methods: The audit comprised three stages: In stage one 1138 patient records in four community practices were examined for information on optometrists' clinical assessment before and after LES training. In stage two, audited optometrists were surveyed on the impact the training had on their routine clinical practice and stage three surveyed all LES accredited optometrists in NI.Results: The records of the optometrists audited in stage one and the responses from stage two showed an increase in the frequency of assessment of the anterior chamber in patients with a family history of glaucoma and an increase in the use of a contact tonometer if IOPs were found to be >21mmHg, subsequent to training. Responses in stage 3 (n=110) regarding the impact of LES training showed that 63{\%} of practitioners felt that the LES training had improved their clinical assessment for signs of glaucoma, however, respondents highlighted the need for more specific feedback from referrals. Conclusions: The LES had a positive impact on practitioners’ choice of pre-referral assessments performed in primary optometric practice.",
keywords = "Glaucoma, optometrist, referral, community",
author = "Shelley Black and McClelland, {Julie F} and Patrick Richardson",
note = "Reference text: Association of Optometrists. 2010. Advice on NICE glaucoma guidelines. (Online) http://www.locsu.co.uk/uploads/glaucoma_faqs_6th_revision_11-02-2010.pdf, accessed 7/5/16 Baker H, Ratnarajan G, Harper RA, Edgar DF, Lawrenson JG. Effectiveness of UK optometric enhanced eye care services: a realist review of the literature. Ophthalmic Physiol Opt 2016 Sep;36(5):545-557. College of Optometrists. 2016. Clinical management guidelines. Glaucoma (primary angle closure) (PACG) (Online) http://www.college-optometrists.org/en/utilities/document-summary.cfm/docid/A292CCFD-42BE-4A3B-9B663C886D463F00 College of Optometrists. 2017. Guidance for professional practice. Examining patients at risk of glaucoma. (Online) http://guidance.college-optometrists.org/guidance-contents/knowledge-skills-and-performance-domain/examining-patients-a/ Congdon NG, Quigley HA, Hung PT et al. (1996) Screening techniques for angle-closure glaucoma in rural Taiwan. Acta Ophthalmol Scand 74, 113–19 Dabasia PL, Edgar DF, Murdoch IE, Lawrenson JG. Noncontact Screening Methods for the Detection of Narrow Anterior Chamber Angles. Invest Ophthalmol Vis Sci 2015 Jun;56(6):3929-3935. Dabasia PL, Edgar DF, Murdoch IE, Lawrenson JG (2013). Methods of Meaurement of the anterior chamber angle Part 1: Angle closure glaucoma and gonioscopy. Optom Pract 14, 107-14 Devarajan N, Williams GS, Hopes M, O'Sullivan D, Jones D. The Carmarthenshire Glaucoma Referral Refinement Scheme, a safe and efficient screening service. Eye (Lond) 2011 Jan;25(1):43-49. Franco, L. M., Daly, C. C., Chilongozi, D. and Dallabetta, G. Quality of case management of sexually transmitted diseases: comparison of the methods for assessing the performance of providers. Bull. World Health Organ (1997) 75, 523–532. Hammel N, Belghith A, Bowd C, Medeiros FA, Sharpsten L, Mendoza N, et al. Rate and Pattern of Rim Area Loss in Healthy and Progressing Glaucoma Eyes. Ophthalmology 2016 Apr;123(4):760-770. Harizman N, Oliveira C, Chiang A, Tello C, Marmor M, Ritch R, et al. The ISNT rule and differentiation of normal from glaucomatous eyes. Arch Ophthalmol 2006 Nov;124(11):1579-1583. Healey PR, Mitchell P, Smith W, Wang JJ. Optic disc hemorrhages in a population with and without signs of glaucoma. Ophthalmology 1998 February 1998;105(2):216-223. Health and Social Care Board, Glaucoma Service update (2015) http://www.hscbusiness.hscni.net/pdf/HSCB_Glaucoma_Service_Update_November_2015.pdf Health and Social Care Board, Northern Ireland Local Enhanced Service, Primary Care Optometry, Glaucoma and ocular hypertension enhanced case finding (Level II local enhanced service) (2016) Healthcare Improvement Scotland. March 2015. SIGN 144 • Glaucoma referral and safe discharge (Online) http://www.sign.ac.uk/pdf/SIGN144.pdf Jamous KF, Kalloniatis M, Hayen A, Mitchell P, Stapleton FJ, Zangerl B. Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines. Ophthalmic Physiol Opt 2014 Sep;34(5):580-591. Jonas JB, Budde WM, Panda-Jonas S. Ophthalmoscopic evaluation of the optic nerve head. Surv Ophthalmol 1999 Jan-Feb;43(4):293-320. Jonas JB, Gusek GC, Naumann GO. Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Invest Ophthalmol Vis Sci 1988 Jul;29(7):1151-1158. Jonas JB, Schiro D. Localised wedge shaped defects of the retinal nerve fibre layer in glaucoma. Br J Ophthalmol 1994 Apr;78(4):285-290. Jonas JB, Xu L: Optic Disc hemhorrages in glaucoma. Am J Ophthalmol 1994 118: 1-8 Keenan J, Shahid H, Bourne RR, White AJ, Martin KR. Cambridge community Optometry Glaucoma Scheme. Clin Experiment Ophthalmol 2015 Apr;43(3):221-227. Klein BE, Klein R, Sponsel WE, Franke T, Cantor LB, Martone J, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology 1992 Oct;99(10):1499-1504. Konstantakopoulou E, Harper RA, Edgar DF, Lawrenson JG. A qualitative study of stakeholder views regarding participation in locally commissioned enhanced optometric services. BMJ Open 2014 May 29;4(5):e004781-2013-004781. Lockwood AJ, Kirwan JF, Ashleigh Z. Optometrists referrals for glaucoma assessment: a prospective survey of clinical data and outcomes. Eye (Lond) 2010 Sep;24(9):1515-1519. Lowe RF (1970) Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol 54, 161–9 Luck, J., Peabody, J. W., Dresselhaus, T. R., Lee, M. and Glassman, P. How well does chart abstraction measure quality? A prospective comparison of standardized patients with the medical record. Am. J. Med. (2000) 108, 642–649 Myint J, Edgar DF, Kotecha A, Murdoch IE, Lawrenson JG. Barriers perceived by UK-based community optometrists to the detection of primary open angle glaucoma. Ophthalmic Physiol Opt 2010 Nov;30(6):847-853. National Institute of Clinical Excellence. 2009. Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension. (Online) https://www.nice.org.uk/guidance/cg85/chapter/1-guidance, accessed 7/5/16 Needle JJ, Petchey R, Lawrenson JG. A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing role. Ophthalmic and Physiological Optics 2008;28(3):193-203. Ratnarajan G, Newsom W, French K, Kean J, Chang L, Parker M, et al. The effect of changes in referral behaviour following NICE guideline publication on agreement of examination findings between professionals in an established glaucoma referral refinement pathway: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project. Br J Ophthalmol 2013 Feb;97(2):210-214. Ratnarajan G, Kean J, French K, Parker M, Bourne R. The false negative rate and the role for virtual review in a nationally evaluated glaucoma referral refinement scheme. Ophthalmic Physiol Opt 2015 Sep;35(5):577-581. Shah S, Murdoch IE. NICE - impact on glaucoma case detection. Ophthalmic Physiol Opt 2011 Jul;31(4):339-342. Shah, R., & Wormald, R. P. L. (2011). Glaucoma. BMJ Clinical Evidence, 2011, 0703. Shah R, Edgar D, Evans BJ. Measuring clinical practice. Ophthalmic Physiol Opt 2007 Mar;27(2):113-125. Ten Kleij F, Musters PAD. Text analysis of open-ended survey responses: a complementary method to preference mapping. Food Quality and Preference 2003 1;14(1):43-52. Thomas, R (2006). Optic disc photograph with disc haemorrhage. [Photograph] (Community Eye Health Journal Vol. 19 No. 59 sept. 2006) Available at: http://www.cehjournal.org/article/how-to-assess-a-patient-for-glaucoma/ [Accessed 11/01/2017] Trikha S, Macgregor C, Jeffery M, Kirwan J. The Portsmouth-based glaucoma refinement scheme: a role for virtual clinics in the future? Eye (Lond) 2012 Oct;26(10):1288-1294. Watkins R, Panchal L, Uddin J, Gunvant P. Vertical cup-to-disc ratio: agreement between direct ophthalmoscopic estimation, fundus biomicroscopic estimation, and scanning laser ophthalmoscopic measurement. Optom Vis Sci 2003 Jun;80(6):454-459. Whittaker KW, Ikram K, Anderson DF, Kiel AW, Luff AJ. Non-communication between ophthalmologists and optometrists. J R Soc Med 1999 May;92(5):2",
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journal = "Optometry in Practice",
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TY - JOUR

T1 - An audit on the impact of training for a Referral Refinement Scheme in Northern Ireland on community optometrists’ clinical practice when assessing for signs of glaucoma

AU - Black, Shelley

AU - McClelland, Julie F

AU - Richardson, Patrick

N1 - Reference text: Association of Optometrists. 2010. Advice on NICE glaucoma guidelines. (Online) http://www.locsu.co.uk/uploads/glaucoma_faqs_6th_revision_11-02-2010.pdf, accessed 7/5/16 Baker H, Ratnarajan G, Harper RA, Edgar DF, Lawrenson JG. Effectiveness of UK optometric enhanced eye care services: a realist review of the literature. Ophthalmic Physiol Opt 2016 Sep;36(5):545-557. College of Optometrists. 2016. Clinical management guidelines. Glaucoma (primary angle closure) (PACG) (Online) http://www.college-optometrists.org/en/utilities/document-summary.cfm/docid/A292CCFD-42BE-4A3B-9B663C886D463F00 College of Optometrists. 2017. Guidance for professional practice. Examining patients at risk of glaucoma. (Online) http://guidance.college-optometrists.org/guidance-contents/knowledge-skills-and-performance-domain/examining-patients-a/ Congdon NG, Quigley HA, Hung PT et al. (1996) Screening techniques for angle-closure glaucoma in rural Taiwan. Acta Ophthalmol Scand 74, 113–19 Dabasia PL, Edgar DF, Murdoch IE, Lawrenson JG. Noncontact Screening Methods for the Detection of Narrow Anterior Chamber Angles. Invest Ophthalmol Vis Sci 2015 Jun;56(6):3929-3935. Dabasia PL, Edgar DF, Murdoch IE, Lawrenson JG (2013). Methods of Meaurement of the anterior chamber angle Part 1: Angle closure glaucoma and gonioscopy. Optom Pract 14, 107-14 Devarajan N, Williams GS, Hopes M, O'Sullivan D, Jones D. The Carmarthenshire Glaucoma Referral Refinement Scheme, a safe and efficient screening service. Eye (Lond) 2011 Jan;25(1):43-49. Franco, L. M., Daly, C. C., Chilongozi, D. and Dallabetta, G. Quality of case management of sexually transmitted diseases: comparison of the methods for assessing the performance of providers. Bull. World Health Organ (1997) 75, 523–532. Hammel N, Belghith A, Bowd C, Medeiros FA, Sharpsten L, Mendoza N, et al. Rate and Pattern of Rim Area Loss in Healthy and Progressing Glaucoma Eyes. Ophthalmology 2016 Apr;123(4):760-770. Harizman N, Oliveira C, Chiang A, Tello C, Marmor M, Ritch R, et al. The ISNT rule and differentiation of normal from glaucomatous eyes. Arch Ophthalmol 2006 Nov;124(11):1579-1583. Healey PR, Mitchell P, Smith W, Wang JJ. Optic disc hemorrhages in a population with and without signs of glaucoma. Ophthalmology 1998 February 1998;105(2):216-223. Health and Social Care Board, Glaucoma Service update (2015) http://www.hscbusiness.hscni.net/pdf/HSCB_Glaucoma_Service_Update_November_2015.pdf Health and Social Care Board, Northern Ireland Local Enhanced Service, Primary Care Optometry, Glaucoma and ocular hypertension enhanced case finding (Level II local enhanced service) (2016) Healthcare Improvement Scotland. March 2015. SIGN 144 • Glaucoma referral and safe discharge (Online) http://www.sign.ac.uk/pdf/SIGN144.pdf Jamous KF, Kalloniatis M, Hayen A, Mitchell P, Stapleton FJ, Zangerl B. Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines. Ophthalmic Physiol Opt 2014 Sep;34(5):580-591. Jonas JB, Budde WM, Panda-Jonas S. Ophthalmoscopic evaluation of the optic nerve head. Surv Ophthalmol 1999 Jan-Feb;43(4):293-320. Jonas JB, Gusek GC, Naumann GO. Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Invest Ophthalmol Vis Sci 1988 Jul;29(7):1151-1158. Jonas JB, Schiro D. Localised wedge shaped defects of the retinal nerve fibre layer in glaucoma. Br J Ophthalmol 1994 Apr;78(4):285-290. Jonas JB, Xu L: Optic Disc hemhorrages in glaucoma. Am J Ophthalmol 1994 118: 1-8 Keenan J, Shahid H, Bourne RR, White AJ, Martin KR. Cambridge community Optometry Glaucoma Scheme. Clin Experiment Ophthalmol 2015 Apr;43(3):221-227. Klein BE, Klein R, Sponsel WE, Franke T, Cantor LB, Martone J, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology 1992 Oct;99(10):1499-1504. Konstantakopoulou E, Harper RA, Edgar DF, Lawrenson JG. A qualitative study of stakeholder views regarding participation in locally commissioned enhanced optometric services. BMJ Open 2014 May 29;4(5):e004781-2013-004781. Lockwood AJ, Kirwan JF, Ashleigh Z. Optometrists referrals for glaucoma assessment: a prospective survey of clinical data and outcomes. Eye (Lond) 2010 Sep;24(9):1515-1519. Lowe RF (1970) Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol 54, 161–9 Luck, J., Peabody, J. W., Dresselhaus, T. R., Lee, M. and Glassman, P. How well does chart abstraction measure quality? A prospective comparison of standardized patients with the medical record. Am. J. Med. (2000) 108, 642–649 Myint J, Edgar DF, Kotecha A, Murdoch IE, Lawrenson JG. Barriers perceived by UK-based community optometrists to the detection of primary open angle glaucoma. Ophthalmic Physiol Opt 2010 Nov;30(6):847-853. National Institute of Clinical Excellence. 2009. Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension. (Online) https://www.nice.org.uk/guidance/cg85/chapter/1-guidance, accessed 7/5/16 Needle JJ, Petchey R, Lawrenson JG. A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing role. Ophthalmic and Physiological Optics 2008;28(3):193-203. Ratnarajan G, Newsom W, French K, Kean J, Chang L, Parker M, et al. The effect of changes in referral behaviour following NICE guideline publication on agreement of examination findings between professionals in an established glaucoma referral refinement pathway: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project. Br J Ophthalmol 2013 Feb;97(2):210-214. Ratnarajan G, Kean J, French K, Parker M, Bourne R. The false negative rate and the role for virtual review in a nationally evaluated glaucoma referral refinement scheme. Ophthalmic Physiol Opt 2015 Sep;35(5):577-581. Shah S, Murdoch IE. NICE - impact on glaucoma case detection. Ophthalmic Physiol Opt 2011 Jul;31(4):339-342. Shah, R., & Wormald, R. P. L. (2011). Glaucoma. BMJ Clinical Evidence, 2011, 0703. Shah R, Edgar D, Evans BJ. Measuring clinical practice. Ophthalmic Physiol Opt 2007 Mar;27(2):113-125. Ten Kleij F, Musters PAD. Text analysis of open-ended survey responses: a complementary method to preference mapping. Food Quality and Preference 2003 1;14(1):43-52. Thomas, R (2006). Optic disc photograph with disc haemorrhage. [Photograph] (Community Eye Health Journal Vol. 19 No. 59 sept. 2006) Available at: http://www.cehjournal.org/article/how-to-assess-a-patient-for-glaucoma/ [Accessed 11/01/2017] Trikha S, Macgregor C, Jeffery M, Kirwan J. The Portsmouth-based glaucoma refinement scheme: a role for virtual clinics in the future? Eye (Lond) 2012 Oct;26(10):1288-1294. Watkins R, Panchal L, Uddin J, Gunvant P. Vertical cup-to-disc ratio: agreement between direct ophthalmoscopic estimation, fundus biomicroscopic estimation, and scanning laser ophthalmoscopic measurement. Optom Vis Sci 2003 Jun;80(6):454-459. Whittaker KW, Ikram K, Anderson DF, Kiel AW, Luff AJ. Non-communication between ophthalmologists and optometrists. J R Soc Med 1999 May;92(5):2

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: The implementation of NICE Clinical Guideline 85 in 2009 increased the number of ocular hypertensive referrals from optometrists into ophthalmology clinics in Northern Ireland(NI). A local enhanced service (LES) was introduced in 2013 as a repeat IOP measure scheme to reduce false positive referrals. This study is a comparative audit of optometrists’ practice in assessing signs of glaucoma, pre and post training for LES accreditation.Methods: The audit comprised three stages: In stage one 1138 patient records in four community practices were examined for information on optometrists' clinical assessment before and after LES training. In stage two, audited optometrists were surveyed on the impact the training had on their routine clinical practice and stage three surveyed all LES accredited optometrists in NI.Results: The records of the optometrists audited in stage one and the responses from stage two showed an increase in the frequency of assessment of the anterior chamber in patients with a family history of glaucoma and an increase in the use of a contact tonometer if IOPs were found to be >21mmHg, subsequent to training. Responses in stage 3 (n=110) regarding the impact of LES training showed that 63% of practitioners felt that the LES training had improved their clinical assessment for signs of glaucoma, however, respondents highlighted the need for more specific feedback from referrals. Conclusions: The LES had a positive impact on practitioners’ choice of pre-referral assessments performed in primary optometric practice.

AB - Background: The implementation of NICE Clinical Guideline 85 in 2009 increased the number of ocular hypertensive referrals from optometrists into ophthalmology clinics in Northern Ireland(NI). A local enhanced service (LES) was introduced in 2013 as a repeat IOP measure scheme to reduce false positive referrals. This study is a comparative audit of optometrists’ practice in assessing signs of glaucoma, pre and post training for LES accreditation.Methods: The audit comprised three stages: In stage one 1138 patient records in four community practices were examined for information on optometrists' clinical assessment before and after LES training. In stage two, audited optometrists were surveyed on the impact the training had on their routine clinical practice and stage three surveyed all LES accredited optometrists in NI.Results: The records of the optometrists audited in stage one and the responses from stage two showed an increase in the frequency of assessment of the anterior chamber in patients with a family history of glaucoma and an increase in the use of a contact tonometer if IOPs were found to be >21mmHg, subsequent to training. Responses in stage 3 (n=110) regarding the impact of LES training showed that 63% of practitioners felt that the LES training had improved their clinical assessment for signs of glaucoma, however, respondents highlighted the need for more specific feedback from referrals. Conclusions: The LES had a positive impact on practitioners’ choice of pre-referral assessments performed in primary optometric practice.

KW - Glaucoma

KW - optometrist

KW - referral

KW - community

M3 - Article

VL - 18

SP - 27

EP - 40

JO - Optometry in Practice

T2 - Optometry in Practice

JF - Optometry in Practice

SN - 1467-9051

IS - 1

ER -