Perspectives and lessons from a community-based collaborative eye care model in Singapore

The Primary Eye Care (PEC) model aimed to right-site patients with non-complex eye conditions by upskilling optometrists. However, there is a paucity of studies examining healthcare professionals' and patients' perceptions and context that influenced implementation of community-based eye care model. This study aimed to explore contextual factors (e.g., interprofessional relationships, patients' perceptions) that influenced implementation of PEC and potential strategies to the identified barriers. Qualitative research design was adopted to elicit the experiences of patients and healthcare professionals. Eight focus group discussions (FGDs) and four in-depth interviews (IDIs) were conducted with 32 healthcare professionals, and 12 IDIs were conducted with 14 patients/caregivers between June 2023 to March 2024. Interviews were transcribed and analysed thematically using an inductive approach. Three themes were identified that influenced the implementation of PEC. First, a bidirectional ophthalmologist-optometrists partnership supported implementation and maintenance of high-quality care. PEC's high-quality care experienced by the ophthalmologists influenced their motivation to refer patients to PEC paving the way for responsibility transfer and role expansion. Second, limited interprofessional interactions between primary care physicians and optometrists impacted the awareness of PEC's services and quality of care, dampening referral motivation. Third, patients' awareness of PEC integration with hospital services and optometrists' capability influenced acceptance of PEC referrals. To enhance primary care physicians' awareness and address patients' concern on PEC integration with hospital services, PEC team will need to prioritise active engagement with primary care physicians and dissemination of interactive patient education.