Implementación y evaluación de una clínica ambulatoria satélite dirigida por optometría para pacientes con diabetes

Collaborative models involving optometrists and ophthalmologists can provide safe, evidence-based, quality care, enhance access to diabetic eye care services, and alleviate pressure on hospital-based ophthalmology services.

Australian hospital-based ophthalmology services face high demand, far exceeding supply. However, many patients with non-sight threatening pathologies may be safely assessed in community settings. This study explored the safety, effectiveness and patient satisfaction of a collaborative diabetic eye care model between a university optometry-led clinic and a public ophthalmology department.

The program implemented a collaboratively developed clinical protocol that minimised the need for direct ophthalmology oversight. Following implementation, a retrospective review of clinical data, post-visit patient satisfaction surveys and a randomised audit of clinical records assessing adherence to care protocols was undertaken. Data were evaluated to determine the models effectiveness in ensuring timely access to care, maintaining clinical safety and patient satisfaction.

Over 18 months, 770 appointments (522 first visits, 248 reviews) were completed. Eighty-one (10.5%) appointments required virtual ophthalmology review and a further 24 (3.1%) required transfer to tertiary ophthalmology. Most (98%) of patients were satisfied with the care they received and adherence to minimum clinical recording, clinical testing and management was 98.7%, 98.9% and 100%, respectively. At the first visit, only 36 (17.5%) patients were seen within 30 days of their recommended review time, compared to 187 (91.2%) at the time of their second visit. Among the 20 patients referred to the hospital for further evaluation and treatment, there was an 85% agreement (K = 0.80) in clinical diagnosis between the optometrist and ophthalmologist.

The model demonstrated that a primary-tertiary care partnership can maintain high standards while improving service efficiency. A collaborative model with reduced dependence on direct ophthalmology oversight can deliver quality care, improve timely access and follow-up for patients with diabetes, with good patient satisfaction.