An audit of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Referral Pathway for Glaucoma Management has been extended from a small pilot in New South Wales to include referrals from all consenting ophthalmologists across Australia.
The aim of the audit is to scientifically assess the effectiveness of the glaucoma referral pathway, one of three referral guidelines introduced by RANZCO in 2016 to promote collaboration and skill development across the eye health sector, particularly between the ophthalmology and optometry professions.
The three pathways for glaucoma, age-related macular degeneration and diabetic retinopathy were developed as part of RANZCO’s commitment to promoting the very best eye health care for people across Australia and New Zealand, and recognising the need to ensure patient referrals to ophthalmologists are appropriate, effective and timely.
The pathways can be used by optometrists and GPs to help guide their referrals and produce the best possible results for patients. These referral guidelines were developed with input from ophthalmologists and optometrists and designed to be impartial, not favouring any particular practice referral system or methodology. Rather, they lay out a simple pathway for optometrists and GPs to follow if they identify certain symptoms.
This study will provide data on how comprehensive glaucoma referrals from optometry are, and provide a feedback mechanism to improve where required
“Collaborative care provides the best possible arrangement for the care of patients,” explains RANZCO President A/Prof Mark Daniell. “The RANZCO guidelines are a simple, evidence-based pathway to guide referrals to ophthalmology, clearly setting standards of care and outlining the roles and responsibilities of all the eye care professionals involved in looking after the patient.”
The first of these guidelines, the RANZCO Referral Pathway for Glaucoma Management, was launched in 2016 and made available to all optometrists and GPs across Australia to download from the RANZCO website.
Recognising the importance of feedback from the people on the frontline using the pathways, RANZCO set up an email address for optometrists and GPs to submit their comments and thoughts – pathways@ranzco. edu. Feedback submitted to RANZCO will be used to help develop and improve the pathways as necessary.
AUDIT OF THE RANZCO REFERRAL PATHWAY FOR GLAUCOMA MANAGEMENT
In addition to feedback from users of the pathways, a scientific method of assessment was required to ensure the effectiveness of the pathways. For this project, RANZCO partnered with Specsavers and the Save Sight Institute to undertake an audit of the way the glaucoma pathway is being used. Working with Specsavers, as the largest network of optometric practices in Australia and New Zealand, allows RANZCO to gather significant metrics and data over a two-year period to assess the effectiveness of the guidelines, while the Save Sight Institute brings its research rigour to the project.
Speaking of the audit process, Dr. Ben Ashby, Head of Optometry for Specsavers Australia and New Zealand said, “We are looking to contribute directly to better diagnosis and better co-management of eye disease in Australia and New Zealand – in this case, we are talking about glaucoma.
“If optometry and ophthalmology can collaborate and take a systematic approach towards referrals, while measuring effectiveness and adjusting the process as required, then we will truly have an opportunity to impact the current situation (50 per cent of patients with glaucoma remain undiagnosed).
“We have 1,000 optometrists on our team, which means we have the ability to make a large scale, systematic and measurable contribution towards better patient outcomes across both countries.”
RANZCO worked closely with Specsavers and the Save Sight Institute to clarify the project roles and expectations around project deliverables, while minimising disruption to practitioner workflow. The project fully complies with ethics requirements, with appropriate consent sought and data de-identified to protect the privacy of optometrists, ophthalmologists and patients.
In 2017, RANZCO rolled out the initial stage of the audit to Specsavers optometry practices in NSW. To standardise the process of data collection, RANZCO designed a proforma listing the requirements of a comprehensive glaucoma referral, including which type of glaucoma diagnosis is suspected. Phase one of the evaluation, the assessment of the quality of glaucoma referrals being provided, is currently underway. Participating clinicians receive feedback regarding their own metrics, allowing reflection and quality improvement. Despite being able to review data on their own referrals, all other practitioner data has been de-identified to protect the privacy of individual practitioners.
After an initial trial with a small number of ophthalmologists in NSW, the study has now been extended to include referrals from all consenting ophthalmologists across Australia.
Dr. Mitchell Lawlor, glaucoma specialist at Sydney Eye Hospital and Chief investigator on the study said, “This study will provide data on how comprehensive glaucoma referrals from optometry are, and provide a feedback mechanism to improve where required. Any system of collaborative care requires the parties involved to be speaking the same language, and this study assists in ensuring this happens.”
ANALYSIS AND REPORTING
In setting up the study, Dr. Lawlor and the study team chose to use a registry created by Save Sight Registries, which tracks and analyses the data gathered from the referrals. Over the two-year pilot period, referrals for glaucoma patients will be submitted by project participants and logged in the custom-built registry, which will automatically assess the quality of those referrals against defined standards.
Personalised, individual reports will be sent back to participating optometrists, advising which aspects of the referral were included, while highlighting any missing information and a description of the final diagnosis as determined by the treating ophthalmologist.
De-identified data will then be used to develop a report on preliminary research findings indicating the proportion of optometrist referrals with a diagnosis that matches the ophthalmologist diagnosis. Data collected over the two-year period, in combination with the feedback provided to optometrists through the registry, will provide an evidence base for the impact of the guideline,
RANZCO Referral Pathway for Glaucoma Management, on the overall accuracy of the glaucoma referrals. RANZCO, Specsavers and the Save Sight Institute hope to see improvements in the accuracy of participating optometrists’ referrals, resulting in earlier diagnosis, more efficient referral practices and overall better eye care for patients.