Is telephone review feasible and potentially effective in low vision services?

Abstract

Purpose: Demographic transformations within the UK population combine to contribute to a substantial increase in demand for low vision (LV) services, creating a pressing need to reconsider the appropriate methods for service provision. In this study, we evaluate the feasibility of using telephone triage to assess the need for, and timing of, LV follow-up appointments. Methods: A cohort of new patients attending the LV Clinic at Manchester Royal Eye Hospital (MREH) was recruited, independent of vision or visual impairment (VI) registration status. Four weeks after this initial clinic assessment, each patient was telephoned and a structured review was conducted. All patients were subsequently followed up at 3 months in the LV clinic. Results: A total of 52 patients were recruited, with the corrected ‘better-eye’ visual acuity (VA) ranging from 0.18 logMAR (6/9.5 + 1) to 1.36 logMAR (6/152 + 2) with a mean of 0.66 logMAR (6/30 + 2). In total, 36 patients completed all aspects of the study. At telephone review, 70 (93%) of the low vision aids (LVAs) loaned were reported to have been used on at least one occasion. Ten patients (22%) were deemed to not require follow-up, 15 (33%) were judged to benefit from an earlier (1 month) review, and 16 (35%) were judged to require 3-month follow-up. Reminding patients at telephone review provided a significant increase in adherence with advice to bring any loaned devices to clinic review ( p < 0.01). Face-to-face clinic review outcomes at 3 months permitted some insight into the effectiveness of telephone triage. Conclusions: Implementing telephone review is feasible for triaging LV follow-up requirements. A number of patient issues can be dealt with immediately and effectively at telephone review, potentially negating the need for a face-to-face clinic review for some patients while identifying a more pressing need for earlier review in others, factors that might improve cost-effectiveness of service provision if subjected to formal health economic evaluation.