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

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.