Changing trends in postoperative cataract care: the role of electronic patient records in facilitating community optometrist-delivered shared care model in a rural Irish setting

Session Details

Session Title: Cataract Surgery Practice Styles

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 08:38

Venue: Boulevard B

First Author: : A.Mongan IRELAND

Co Author(s): :    F. Kerins   B. McKenna   S. Quinn   P. Mullaney     

Abstract Details

Purpose:

Cataract surgery comprises a significant aspect of ophthalmic hospital practice and this demand is predicted to increase further as the population ages. Postoperative shared care with community optometrists could reduce the need for follow-up appointments to the hospital ophthalmology department, thus enabling better use of valuable resources. There is a paucity of evidence regarding discharge to a community-based service, and the utility of electronic patient records (EPR) in this setting. The aim of this study is to evaluate a community optometrist-delivered postoperative care scheme in patients who underwent same day discharge from the hospital ophthalmology department following cataract surgery and to assess the efficacy of EPR in facilitating co-managed cataract care.

Setting:

Sligo General Hospital serves a large and predominantly rural catchment area. Ophthalmic services are offered on a regional basis from the Sligo base, often on an out–patient and outreach basis. Community optometrists within this catchment area were invited to participate in the postoperative cataract shared care scheme. Optometrists attended an information session outlining the patient pathway, completion of the Medisoft electronic patient record (EPR), identification of postoperative complications and procedures for re-referring patients with postoperative complications as well as patients requesting second eye cataract surgery. A total of 39 optometric practices took part in this pilot co-management scheme. Patients undergoing uncomplicated surgery with no significant ocular comorbidity were eligible for same day discharge to community optometrists. Patients who had intraoperative complications, or in whom there were significant ocular comorbidities were followed up by the doctor-led clinic in the hospital.

Methods:

We performed a retrospective analysis of a prospectively maintained database of postoperative cataract review data over a six month period from October 2012 to April 2013. Demographic, clinical, and outcome data were retrieved from this Medisoft database. These records were assessed to see how complete they were in terms of postoperative clinical details (refraction, visual acuity, intraocular pressure and cup disc ratio) and follow-up plans. Data were analysed with SPSS version 18 for Windows (IBM, Armonk, New York, USA) software. Categorical variables were analysed with Fisher’s exact test. Statistical significance was defined by p ≤0.05.

Results:

Over the study period of six months, 913 cataract surgeries were performed in Sligo General Hospital (55% female, 45% male). A total of 614 patients (67%) were discharged to the community on the day of cataract surgery. Complete postoperative feedback (i.e. data on refraction, visual acuity, intraocular pressure and cup disc ratio) was available in 77% of these patients compared to 8% of patients reviewed in the hospital. Patients followed up in the community were ten time more likely to have complete postoperative clinical details (RR=10.17, 95% CI: 6.951-14.88, p<0.0001). Overall 66% of operations were performed on first eyes. Location of follow-up did not influence the likelihood of be being listed for second eye surgery (RR=1.237, 95% CI 0.9822-1.558, p=0.08). Optometrists were less likely to document follow-up plans compared to hospital doctors (RR=0.4924, 95% CI: 0.4059-5973, p<0.0001).

Conclusions:

As a result of the shared care scheme there were fewer postoperative follow-up appointments to the hospital over the course of the six months. Optometrists provided an excellent postoperative care service with superior postoperative feedback rates compared to hospital doctors and similar rates of re-referring for second eye surgery. The use of EPR facilitates a postoperative shared care pathway that is of high quality and efficiency with major economic advantages.

Financial Interest:

NONE