Glaucoma co-management: CHANGES

12 months ago I started a new position at Hinchingbrooke Hospital as an ‘optometrist with a special interest in glaucoma’.  This post was created specifically with a view to setting up and administering a glaucoma community co-management scheme.  Glaucoma co-management is not a new idea and several schemes currently operate around the country.  However it is unlikely to have escaped people’s attention that the current government are very keen to divert patients out of hospitals and into community care! 

CHANGES (Community and Hinchingbrooke Allied Network Glaucoma Evaluation Scheme) went ‘live’ last August within the Huntingdonshire area.  It is being established in phases, starting with a referral refinement phase, to be followed by co-management of low risk patients.  Eight community optometrists have been accredited as optometrists with a special interest in glaucoma (OSIs).  CHANGES is unusual among the currently operating schemes around the country in that it has received no start-up funding from the department of health (yes - the government are very keen for us to set up community schemes as long as they don’t have to give us any money to do it!!)

The referral refinement stage of the scheme involves redirecting referrals that are perceived to be low risk (probable false positives) to the appointed OSIs, offering the patients a choice of locations.  The OSI carries out a full evaluation to include Goldmann tonometry, Humphrey visual fields and dilated stereoscopic evaluation of the optic disc and retinal nerve fibre layer.  A decision then has to be made as to whether the patient needs referring on to the hospital glaucoma service or whether they can be discharged as a false positive. 

The second phase of CHANGES will involve ocular hypertensives and stable glaucoma patients being seen by OSIs within the community.  These patients will have been evaluated by the hospital glaucoma service and an individual care plan drawn up.  The OSI will see the patient with a frequency stated in the care plan and will carry out an examination, specifically looking for evidence of progression. 

Currently about 30% of all new hospital referrals for glaucoma are entered into CHANGES.  Of the patients seen by OSIs, 30% are being discharged successfully, reducing the number of false positive referrals reaching the hospital.  Patients who still need referral in to the hospital from the OSI come with standardised and improved quality referral information.

The scheme is obviously still in its infancy and not without a few hiccups but it seems to have been well received by both patients and local optometrists. 

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