Virtual glaucoma services in Finland

Abstract

AbstractThe number of patients using reimbursed glaucoma medications in Finland has increased 2.4‐fold since 1986 and increases by 2.5 % every year. In 2020, 100 000 patients are expected to be using glaucoma drops in a population of 5.4 million. Simultaneously the gap between diagnostic and therapeutic possibilities and available resources is broadening more rapidly. It is obvious that radical changes and new insights in attitudes and policies are mandatory to make the glaucoma processes more cost‐effective and to be able to guarantee access to high quality, high volume and low cost care. There is a continuous trade‐off ‘right’ level or services. Paradoxically, just adding more care may not always be better. What is too early vs. too late diagnosis? What represents under‐ vs. over treatment in glaucoma care? Is ‘good enough’ enough? With limited resources more resources are allocated for patients with greatest risk of visual disability. Physicians’ time is spent in developing the health care system to find and segment the aggressive and rapidly progressive glaucoma patients from ‘usual’ stable patients ‐ as well as organizing and supervising the work of other professionals and care processes. As it is very expensive – time and money wise – to receive simple care from highly trained professionals (e.g. tonometry‐based follow‐up of glaucoma), shared care is of utmost importance. Whatever we do, we start by asking whether the intervention (test, treatment, care protocol etc) is necessary, i.e. beneficial to the patient’s well being. If the answer is ‘yes’– and the society affords the intervention ‐ the next question asks who should do it and could technology substitute professionals (e.g. imaging, home‐tonometer etc). As it is especially the cumulative effect of small changes in clinical practices (e.g. adding new diagnostic tests or therapy) that has a massive impact on the healthcare budgets, clinician weighs not only their benefits and risks but should also consider the costs. Whenever we wish to add more care, we simultaneously consider removing unnecessary old interventions and preventing the adoption of useless new interventions. The principles of virtual glaucoma virtual glaucoma services in Finland can be summarized as the priorization and segmentation (most resources allocated to prevent permanent visual disability), standardization and efficient ways to produce services as well as shared care among different professionals and patients.