A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

Abstract

Background

Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease.

Methods

The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six-months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted.

Results

Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non‐angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001).

Conclusions

The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities.

Key words:

• collaborative care
• eye care
• glaucoma
• gonioscopy
• narrow angles
• referral refinement

ACKNOWLEDGEMENTS

This work was supported in part by the National Health and Medical Research Council of Australia (NHMRC #1033224). Guide Dogs NSW/ACT are partners in the NHMRC grant. The authors thank Dr Warren Apel for his clinical expertise. The authors also thank Judy Nam for technical assistance.

Supporting information

Additional supporting information may be found in the online version of this article at the publisher’s website: http://onlinelibrary.wiley.com/doi//suppinfo.

Figure S1. Clinical workflow at Centre for Eye Health for glaucoma‐specific referrals relevant to the present study. The dashed arrows indicate the times determined in the study between key points in workflow. The blue dashed lines indicate time from referral receipt to appointment, and the green lines indicate time from appointment to reporting.

Additional information

Funding

National Health and Medical Research Council of Australia