Glaucoma referrals from primary care and subsequent hospital management in an urban Australian hospital


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Abstract

BackgroundPublic hospital ophthalmology services are in high demand and patients requiring medical or surgical intervention for glaucoma may worsen while awaiting care. In Australia, tertiary hospital care requires a referral from primary care providers. This study investigates the quality of glaucoma referrals received at a tertiary public hospital in Australia, and describes the types of glaucoma cases referred for hospital management.MethodsAn investigation of 200 sequential glaucoma referrals received at a major Australian public hospital from 2013–2016, and the subsequent hospital management. A clinical file audit was made of patient medical records, including referral letters to extract the referral content, and the hospital glaucoma diagnostic outcomes and patient management.ResultsMost referrals came from optometrists (72 per cent) and general practitioners (22 per cent) with the remainder from other specialists. The majority of the referrals contained less than 50 per cent of the key clinical and demographic parameters. Referrals from optometrists provided more ophthalmic information (visual acuity, visual field, intraocular pressure, ocular history). Referrals from general practitioners contained more medical information (systemic co-morbidities medication and allergies). The median wait-time from referral to hospital appointment was 400 days. Of patients attending a hospital appointment, 59 per cent required surgical or medical management, and 16 per cent did not have glaucoma. Overall 18 per cent were discharged, with no differences noted by referral content or referring practitioner.ConclusionMost referrals did not include useful diagnostic information on ocular, medical and social risks for glaucoma. There is an opportunity to improve targeting of primary care referrals for glaucoma, since patients who were discharged immediately after their hospital appointment are exacerbating the long hospital wait-time. Better information transfer may help to identify patients requiring more urgent intervention. A standardised referral template and guidelines would support collaborative care and streamline access to hospital services.

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