Evaluating a collaborative paediatric eye-care model between optometry and ophthalmology: a clinical audit.

Abstract

Clinical relevance: Collaborative care models between optometry and ophthalmology can be a safe and viable way to improve patient access to paediatric eye-care services and reduce hospital paediatric load.

Background: Long waiting lists exist for paediatric ophthalmology services Australia-wide, yet some patients who are referred to the hospital may not require hospital-based treatment and instead can be seen in primary care. This audit assessed the safety and standard of care provided in a paediatric collaborative care model between a student-led university optometry clinic and a public ophthalmology clinic. Supervising optometrists in the optometry clinic were experienced in the care of paediatric patients. Collaborative care was provided for children with juvenile idiopathic arthritis, craniosynostosis (without strabismus/amblyopia), nasolacrimal duct obstruction or chalazion, following a co-developed care protocol.

Methods: Outcome data (throughput, re-referrals, waiting list removals) were collected through both clinics. A retrospective case note audit (randomised record selection across the four included conditions) was undertaken, assessing percentage compliance against the co-developed care model protocol. Patient satisfaction with the collaborative care clinic was assessed by patient reported experience survey for clinic attendees in a one-month period.

Results: One hundred and fifty-seven of 169 children offered the care pathway received care through the collaborative model, with 209 patients being removed or prevented from being added to the Royal Children's Hospital Ophthalmology waiting list. Collaborative care protocol compliance was 95%. Twenty-nine children were re-referred for ophthalmological intervention. Parents/guardians of 11 children completed the survey, reporting 100% satisfaction.

Conclusions: Collaborative care between hospital-based ophthalmology and university-based optometry can be effectively implemented in a student-led clinic, resulting in reduced hospital wait times, high clinician adherence to protocols and high family satisfaction.