A Mixed-Methods Evaluation of a Community-Based Glaucoma Check Service in Hackney, London, UK

ABSTRACT

Purpose: To evaluate the uptake, feasibility and acceptability of a general practice-based optometrist-led glaucoma check service. The service targeted people of black Caribbean and black African descent aged 40–65 years, resident in Hackney, London, United Kingdom.

Methods: The study used a mixed-method design, including analysis of service data, prospective audit of secondary care referrals patient survey, cost-consequence analysis, and interviews with staff involved in developing and implementing the service.

Results: A total of 3040 patients were invited to undergo the free check; 595 (19.6%) booked an appointment and 461 (15.2%) attended. Overall, 31 patients (6.8%) were referred to secondary care, of whom 22 attended and were assessed for glaucoma. Four were diagnosed with glaucoma and eight with suspected glaucoma, i.e. 2.6% of patients who underwent the check. The cost per patient identified with suspected or confirmed glaucoma was £9,013. Staff who were interviewed suggested that patients who attended might be those who routinely attended optometrist appointments, however only 62.4% of survey respondents reported having had an eye examination in the previous two years, and 11.4% of women and 16.0% of men reported never having had an eye examination.

Conclusion: This study represents one possible configuration for a glaucoma case-finding service, and it contributes to a wider debate about whether screening, targeted or otherwise, should be offered in the UK. Our findings suggest that general practice is an acceptable setting and that such a service may reach some people not previously engaged with primary eye care services.

KEYWORDS:

• Check
• evaluation
• general practice
• glaucoma
• mixed methods
• screening

Acknowledgments

We thank those who contributed to the evaluation by providing us with data, participating in interviews or helping with research tasks, including: patients who completed questionnaires; optometrists who took part in an interview; Eileen Katipunan, Jill White, and staff at the host general practice (The Nightingale Practice); staff at participating general practices (Athena Medical Centre, Barton House Group Practice, Lower Clapton Group Practice); Poonam Sharma, Sarah Everiss, Monica Zenonos, and staff at NHS East London & City Primary Care Trust; Sarah Hughes, LSHTM MSc student, for compiling general practice data; David Grant, LSHTM IT Officer, for his graphics assistance, and RNIB for their support of the evaluation.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the writing and content of this article.

Funding

The evaluation was supported by funding from RNIB. The intervention was supported by funding from RNIB and NHS East London & City Primary Care Trust.

Additional information

Funding

The evaluation was supported by funding from RNIB. The intervention was supported by funding from RNIB and NHS East London & City Primary Care Trust.

Notes on contributors

Elizabeth Holdsworth

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Jessica Datta

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Dalya Marks

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Hannah Kuper

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Helen Lee

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Shaun Leamon

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Robert Lindfield

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Richard Wormald

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Jonathan Clarke

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Ahmed Elkarmouty

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.

Wendy Macdowall

The authors declare that EH, DM, JD, and WM had salary support from RNIB from 2012 to 2015 for the submitted work. HL and SL were employed by RNIB at the time of the study. JC, AE, and RW were supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. No financial support was received for the other authors’ involvement.