Abstract
BackgroundPopulation aging increases the number of glaucoma patients which leads to higher workloads of glaucoma specialists. If stable glaucoma patients were monitored by optometrists and ophthalmic technicians in a glaucoma follow-up unit (GFU) rather than by glaucoma specialists, the specialists' workload and waiting lists might be reduced.We compared costs and quality of care at the GFU with those of usual care by glaucoma specialists in the Rotterdam Eye Hospital (REH) in a 30-month randomized clinical trial. Because quality of care turned out to be similar, we focus here on the costs.MethodsStable glaucoma patients were randomized between the GFU and the glaucoma specialist group. Costs per patient year were calculated from four perspectives: those of patients, the Rotterdam Eye Hospital (REH), Dutch healthcare system, and society. The outcome measures were: compliance to the protocol; patient satisfaction; stability according to the practitioner; mean difference in IOP; results of the examinations; and number of treatment changes.ResultsBaseline characteristics (such as age, intraocular pressure and target pressure) were comparable between the GFU group (n = 410) and the glaucoma specialist group (n = 405).Despite a higher number of visits per year, mean hospital costs per patient year were lower in the GFU group (€139 vs. €161). Patients' time and travel costs were similar. Healthcare costs were significantly lower for the GFU group (€230 vs. €251), as were societal costs (€310 vs. €339) (p < 0.01). Bootstrap-, sensitivity- and scenario-analyses showed that the costs were robust when varying hospital policy and the duration of visits and tests.ConclusionWe conclude that this GFU is cost-effective and deserves to be considered for implementation in other hospitals.
Highlights
Population aging increases the number of glaucoma patients which leads to higher workloads of glaucoma specialists
Eyes were considered to be glaucomatous if they had typical thinning or notching of the neuroretinal rim of the optic nerve head, with or without disc haemorrhages, visual field defects, peripapillary atrophy and/or and elevated intraocular pressure (IOP); (2) a glaucoma specialist of the Rotterdam Eye Hospital (REH) referred the patient to the glaucoma follow-up unit (GFU); (3) the actual ophthalmic medication and the target pressure (TP) was recorded in the medical record
Of the GFU employees to the standard working protocol, 2) patient satisfaction with the following items: a) overall mark for the received care; b) social interaction with the health care provider; c) expectations about the visit; d) perceived knowledge of the health care provider; e) waiting area, 3) stability according to the practitioner, 4) mean difference of the IOP (IOP at baseline vs. IOP at the last visit, 5) the results of the examinations and, 6) the number of treatment changes
Summary
Population aging increases the number of glaucoma patients which leads to higher workloads of glaucoma specialists. If stable glaucoma patients were monitored by optometrists and ophthalmic technicians in a glaucoma follow-up unit (GFU) rather than by glaucoma specialists, the specialists’ workload and waiting lists might be reduced. We compared costs and quality of care at the GFU with those of usual care by glaucoma specialists in the Rotterdam Eye Hospital (REH) in a 30-month randomized clinical trial. Usual care for glaucoma patients consists of diagnosis, lifelong monitoring and treatment, and in most countries is currently provided by glaucoma specialists. Ophthalmic care in the Netherlands is currently being challenged by a high workload for glaucoma specialists and long waiting lists. Due to ageing of the population, the prevalence of glaucoma probably will increase strongly over time [1], possibly endangering access to glaucoma care as currently provided. Task substitution may be one way to ease this problem
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