Demographics, referral patterns and management of patients accessing the Welsh Eye Care Service
McAlinden et al. Eye and Vision
Demographics, referral patterns and management of patients accessing the Welsh Eye Care Service
Colm McAlinden 0 1
Helen Corson 1 3
Nik Sheen 1 2
Peter Garwood 1 3
0 Public Health Wales , Floor 11 , The Oldway Centre , 36 Orchard Street, Swansea SA1 5AQ , UK
1 Presented as a poster at the Royal College of Ophthalmologists Annual Meeting
2 School of Optometry and Vision Sciences, Cardiff University , Maindy Road, Cardiff CF24 4 LU , UK
3 Public Health Wales , Cwmbran House, Mamhilad Park Estate, Pontypool, Torfaen NP4 0XS , UK
Background: The Primary Eyecare Acute Referral Service (PEARS) and the Wales Eye Health Examination (WEHE) operate as enhanced optometry services for patients residing in Wales, enabling the examination of a patient presenting with an acute eye problem (PEARS) or the examination of patients at higher risk of eye disease (WEHE). The purpose of the study is to assess the demographics of patients accessing these services, referral patterns and clinical management in one Health Board in Wales (Aneurin Bevan University Health Board). Methods: Information from 2302 patients accessing the services was prospectively collected. The following information was obtained: type of examination (PEARS or WEHE), patient age, gender, self-referral or general practitioner (GP) referral and clinical management (no further action, monitor by optometrist or ophthalmic medical practitioner [OMP], refer to the Hospital Eye Service [HES], or refer to GP). Results: There were 1791 (77.8 %) PEARS examinations and 511 (22.2 %) WEHE. There were 1379 (59.9 %) females with a mean age of 58.61 (±19.75) and 923 (40.1 %) males with a mean age of 56.11 (±20.42). The majority of patients were self-referrals compared to GP-referrals (1793 [77.9 %] versus 509 [22.1 %] respectively). Sub-analysis indicated similar numbers of self-referrals compared to GP-referrals for the WEHE only (297 [58.1 %] versus 214 [41.9 %] respectively) but greater numbers of self-referrals for the PEARS examinations only (1496 [83.5 %] versus 295 [16.5 %] respectively). For management, 75 % of patients were monitored by their optometrist or OMP, 17 % required referral to the HES and 8 % required referral to their GP. Conclusions: Higher numbers of females accessed both PEARS and WEHE services and the majority of patients self-referred. These findings have important implications for public health campaigns both for targeting specific groups (e.g. male patients) and increasing awareness among GPs.
Wales eye care services; Primary eyecare assessment & referral service; Welsh eye care initiative; Welsh eye health examination
Background
The Primary Eyecare Acute Referral Service (PEARS)
and the Wales Eye Health Examination (WEHE) were
enhanced optometry based services that had operated
for 10 years for patients residing in Wales [
1
]. Patients
generally either self-refer or are referred by their General
Practitioner (GP) to accredited practitioners in community
optometry practices. Patients requiring a PEARS
examination are able to be seen within 24 h and undergo
appropriate investigations at the discretion of the practitioner while
patients attending for a WEHE undergo standard
predetermined ophthalmic investigations [
1
]. These services were
funded by the Welsh Government at no cost to the patient,
enabling the examination of a patient presenting with an
acute eye problem (PEARS) or the examination of patients
at increased risk of eye disease (WEHE). The
reimbursement was £60 for a PEARS and £40 for a WEHE. In April
2013, these services were amalgamated into the new Eye
Health Examination Wales (EHEW) Service with the core
aims of the service kept the same as the previous
PEARS and WEHE. The services are part of the wider
Welsh Eye Care Service (WECS), which also includes
the Low Vision Service Wales and Diabetic Retinopathy
Service Wales [
2–6
]. All the WECS services continue
to be updated and further information is available on
the website www.eyecare.wales.nhs.uk [
7
]. In brief, the
PEARS and WEHE service core values have been
retained within a new Eye Health Examination Wales
(EHEW) service launched in 2013. The EHEW service
contains a structured framework that operates on a
3tiered banded system. The Band 1 part of the EHEW
service retains all the previous categories of the PEARS
and WEHE service in an amalgamated format. The
additional Bands 2 and 3 enable community
optometrists to further inform or prevent onward referral to
the hospital eye service, or carry out a follow up
assessment of a patient, respectively.
Optometrists and ophthalmic medical practitioners
(OMPs) are required to undergo accreditation, which
involves successful completion of distance learning
lectures with multiple choice questions, and practical
Objective Structured Clinical Examinations (OSCEs).
The purpose of the present study is to assess the
demographics of a sample of patients accessing this
service, referral patter (...truncated)