Feasibility of providing collaborative glaucoma care from a community optometry perspective: a mixed-methods assessment

ABSTRACT

Clinical relevance

Despite evidence showing that optometry-led collaborative glaucoma care can be delivered at reduced cost compared to ophthalmology-based care without compromising patient outcomes, such models of care are not widely practiced in Australia. Ensuring glaucoma patients have equitable access to effective and cost-effective care is a matter of public health importance.

Background

This study examined the feasibility and business case assessment for providing glaucoma care from a community optometry perspective.

Methods

Nine optometrists were interviewed in a semi-structured format, focusing on the economic feasibility, barriers, and benefits of collaborative glaucoma care. The Consolidated Framework for Intervention Research was used for thematic data analysis. Costs and revenues associated with providing glaucoma care were sourced from the literature and interviews. A business case model assessing the profitability of glaucoma care in optometric practice was developed.

Results

Thematic analysis revealed concerns over financial viability such that current Medicare Benefits Schedule fees are not sufficient to justify the cost of running a community optometry glaucoma clinic. All participants received a supplementary source of revenue. This finding was confirmed by the business case assessment. Inter-professional trust was perceived to be a key barrier to initiation of collaborative care however was able to be overcome quickly upon commencement of a collaborative care relationship. Optometrists perceived that collaborative care was beneficial to all involved, including patients, ophthalmologists, optometrists, and health payers. There was a perception of a growing divide between clinical and retail optometry, which was thought by most participants to be appropriate.

Conclusion

This study is the first to explore the feasibility and business case for community-based optometrists to provide collaborative glaucoma care in Australia. Our findings show that current public funding is insufficient to justify the business case to private optometry practice, despite being perceived by optometrists as beneficial to all involved.

KEYWORDS:

• Business case
• clinical optometry
• collaborative care
• glaucoma
• qualitative research

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/08164622.2023.2175602

Acknowledgments

This research was funded by Optometry Australia. The authors would like to thank all participants for their time, as well as the team at Optometry Australia for their assistance developing and reviewing the interview guide and support throughout this research.

Disclosure statement

RM, ID and CT and all paid employees of HTANALYSTS. HTANALYSTS received payment from Optometry Australia for a project used to develop this manuscript. Optometry Australia identified optometrists to be interviewed and reviewed the discussion guide. Optometry Australia had no input into the analysis of interview data or development of the manuscript. LK and JHL have no conflicts of interest to declare.

Additional information

Funding

HTANALYSTS received funding for this research from Optometry Australia.