Toward Better Health Outcomes in Rural and Under-served Areas: L. V. Prasad Eye Institute’s Diagonal Model of Glaucoma Care

ABSTRACT

Purpose: L. V. Prasad Eye Institute has adopted horizontal approach of eye care delivery for the past 22 years at one of its rural secondary centers. The recent implementation of a diagonal model for enhancing glaucoma care at this center and its outcomes are reported.

Methods: This was a retrospective case-control study. We included newly and consecutively diagnosed adult glaucoma patients. A comprehensive ophthalmologist provided glaucoma care. During the study period, an experienced glaucoma specialist supported the care for 2 days every month in a structured format that consisted of triaging glaucoma patients for defined protocols of therapy along with hands-on and remote online guidance to the comprehensive ophthalmologist. The data from the worst or single eye were analyzed.

Results: We have included 231 patients (151 study and 80 historical controls). Sixty (75%) control patients were managed at the study center and 20 (25%) were referred. The comprehensive ophthalmologist managed 70 (48.2%) study patients and co-managed 75 (51.7%) with the glaucoma specialist. The latter changed the diagnosis in 15 eyes and altered the treatment plan in 44 eyes. Six were excluded. Successful outcome was achieved in 52 (65%) eyes in the control group and 120 (84.5%) eyes in the study group (P < .01). Additionally, study group did better in terms of case detection rate, compliance to treatment and saving on expenses for patients.

Conclusion: The new model has shown better clinical outcomes of glaucoma care in an under-served geographic area. The model has the potential for wider applicability.

KEYWORDS:

• Health care delivery
• Eye care
• Health outcomes in rural and under-served areas
• Diagonal health care
• Diagonal model

Acknowledgments

We thank Mr. Sandeep Dayal, Administrator of the study center for his help at various stages in execution, Dr. Sreedevi Yadavalli for English language editing and Dr. Virender Sangwan for the discussions on the project.