Towards a shared care model for stable diabetic retinopathy patients: a feasibility trial in Singapore

Abstract

PurposeWhile diabetic retinopathy (DR) is a chronic disease, patients in Asian’ health care systems are often managed within hospital settings. Aim of this feasibility study is to assess the quality of care and economic benefits of a shared care model managing patients with stable DR in a primary eye care clinic (PEC) compared with a current tertiary specialist outpatient clinic (SOC) in Singapore.MethodsA randomized equivalence feasibility trial was performed, to compare a PEC with a SOC. The trial patients included those previously seen at the SOC, and having no DR or stable mild non proliferative (NPDR) with no macular edema, no visual and DR deterioration. Primary outcomes were clinical management. Secondary outcomes were patient satisfaction and cost of consultation. Differences analysis used equivalence testing and generalized odds ratios (GOR).ResultsThe trial included 231 patients, 83.1% classified as no DR (PEC: 79.1%; SOC: 87.1%) and 16.9% as stable mild NPDR (PEC: 20.9%; SOC: 12.9%). DR management at PEC was significantly equivalent to that received at the SOC (rate difference 2.56%; CI:(−1.61% to 6. 74%)) and 4.29%;CI: (0.14%–8.45%), respectively. Patient satisfaction at the PEC was high when compared to SOC (GOR: 1.71; CI: (0.50–2.00)). Direct costs per patient visit were 45% lower at PEC compared to SOC.ConclusionsOur feasibility trial showed that patients with no or stable DR receive similar clinical care and management at a lower‐cost PEC setting, are equally satisfied with the service compared to tertiary eye care. A follow‐up study is necessary to validate these findings. Managing stable DR patients at a PEC may be a safe and effective shared care model to improve accessibility for patients while enhancing professional collaboration between hospital and community settings.