Shared care in glaucoma: a national study of secondary care lead schemes in England

Abstract

To determine the number and nature of shared care schemes for glaucoma and glaucoma suspects operating in England. A two-stage investigational process targeting all secondary-care ophthalmic departments with junior medical staff. An initial telephone contact for basic data (March 2006) was followed by a detailed questionnaire for completion by the scheme lead (May 2006). The telephone contact showed that of the 131 eligible ophthalmic departments, 76 claimed to be operating a glaucoma-based shared care scheme. Questionnaires were returned from 74 of the 76 departments claiming to run a scheme, showing that there were only 66 schemes operating in mid 2006 in association with 62 departments. Of these, 14 were community-based (predominantly run by trained optometrists) and 52 operated 'in-house' (predominantly involving nurses and optometrists). Most schemes were <6 years old and of the 30 schemes seeing new patients, 14 (47%) did not use gonioscopy as part of the assessment. In 8 schemes (12%), the shared care staff members were able to prescribe medication for glaucoma. In England, even before the outcome of the Department of Health shared care pilots had been published, approximately 50% of ophthalmic departments were running shared care schemes for glaucoma. However, most schemes contributed only modestly to the overall volume of glaucoma care, indicating that the majority of glaucoma-related consultations still occur directly with ophthalmologists. The Royal College of Ophthalmologists guidelines on gonioscopy are not being followed in almost half of the schemes seeing new patients.