Primary Eyecare Glaucoma Service (PEGS): a mixed methods service evaluation.

Abstract

A pilot study to assess the safety and efficacy of a Primary Eyecare Glaucoma Service (PEGS), with low-risk glaucoma patients being reviewed within primary care optometry. 98 low-risk glaucoma patients were identified as suitable for monitoring in primary care and reviewed by accredited optometrists in community practice supported by a clinical management plan. Safety was assessed by reviewing concordance of management plans created by primary care optometrists and the secondary care team. Patients' and primary care optometrists' feedback were collated via surveys. Carbon emissions were calculated through comparison of patient travel to primary and secondary care. 93.8% of patients reviewed by primary care met criteria for ongoing monitoring in primary care after initial review with 4.9% of patients being recalled to secondary care due to clinical instability. Safety and efficacy were demonstrated with agreement of management plans between primary and secondary care of 97.8%, kappa =0.88 (95% confidence intervals 0.60-1.00), with no patients being identified as false negatives where recall back to secondary care was required. Overall satisfaction with PEGS was 100% according to a patient survey. Respondents of the primary care optometry survey felt very or somewhat confident in delivering care, with comments suggesting they felt supported by secondary care. Carbon emissions are reduced by approximately two thirds when patients are seen in primary care versus attending the hospital. PEGS is a safe and effective service, reducing the burden for secondary care, while carbon emissions are reduced due to shorter travelling distances, demonstrating environmental sustainability.