Comparison of the effectiveness of two enhanced glaucoma referral schemes

Purpose: To compare the clinical and financial effectiveness of two optometricled enhanced glaucoma referral schemes in the Bexley Care Trust area. Methods: Over a 12-month period all suspect glaucoma/Ocular Hypertension (OHT) referrals from optometrists relating to patients registered with Bexley GPs were analysed. All these patients were examined under one of two schemes. One was an enhanced glaucoma repeat measurement (EGRM) scheme in which the referring optometrist conducted the repeated tests him/herself prior to referral or non-referral. The alternative was a refinement pathway (RCAS) using a small team of accredited community optometrists. Results: During the full year commencing April 2007, repeat measures using the EGRM scheme resulted in 76% of patients not being referred. In 44.5% of all EGRM patients, where raised intraocular pressure (IOP) was found by non-contact tonometry (NCT), repeated measurement by Goldmann/Perkins applanation tonometry resulted in readings that were <22 mmHg, or that had less than a 5 mmHg difference between the two eyes. Financial review demonstrated that the EGRM achieved 62% savings when compared with HES tariff while RCAS resulted in a saving of 3.5%. Conclusions: Using a primary care repeat measurement scheme to support referral decision-making demonstrated substantial cost benefit while onward referral for refinement by accredited optometrists was essentially cost-neutral compared with HES tariff. Local schemes foster fragmentation and consideration should be given to a service which covers a large population area.