Proposed AMD Pathway. Start

Transcription

1 Proposed AMD Pathway Start 1. Patient attends optometrist with special interest (OSI) Differential diagnostic assessment, including full history, clinical examination, biomicroscopy and macular function Patient has non-neovascular AMD Patient has neovascular AMD -OSI refers directly to HES 2. Patient attends HES Outpatient appointment with ophthalmologist* AMD untreatable AMD treatable (* flourescien angiography and further investigation ) 4. Fast access to integrated low vision services optical low vision services advice and information counselling social service support rehabilitation possible certification (CVI) 3. Patient attends HES Access to treatment Advice and information etc for patient

2 Delivering the Vision

3 Chronic Eye Disease (AMD) Management GEK ONG Project Manager, Sussex Eye Hospital Brighton & Hove City

4 Brighton & Hove AMD Management Programme Brighton & Hove City PCT Brighton & Sussex University Hospital NHS Trust Brighton & Hove Social Services Local Optometrist Committee Local AMD Support Group

5 Project Aim To develop an integrated, patient-centred eyecare service model for patients with AMD

6 Project Objectives Training for selected optometrists to maximise ability to triage AMD accurately Rapid access for appropriate patients with AMD to specialist AMD clinics one-stop community based low vision services with social services and rehabilitation support etc

7 3 Key Steps IMPROVING ACCESS ENHANCING HES SERVICES STREAMLINING LOW VISION SUPPORT & VOLUNTARY NETWORKS

8 CO Wet AMD Suspected Wet AMD Dry AMD Other Pathology COSI Wet or Suspected Wet AMD Dry AMD Other Pathology GP AMD Rapid Assessment SEH Low Vision Co-ordinator PDT Treatment Low Vision Services Rehabilitation Support Social Services Support

9 Key Step 1 IMPROVING ACCESS by enhancing the role of community based optometrists

10 Community Optometrist with Special Interest (COSI) 2 accredited COSIs in Brighton & Hove Triaging Role: Wet or suspect Wet AMD Dry AMD Training programme Lecture: project aims, referral pathway, support services, clinical features of AMD Clinic visits: AMD assessment, FFA, PDT FU training on other macular conditions

11 Key Step 2 ENHANCING HES SERVICES to provide streamline & one-stop access to investigation/treatment clinic for patients with wet or suspected wet AMD (Direct Referral via COSI only)

12 ENHANCING HES SERVICES AMD Clinic Ophthalmologist NO FFA neede d? YES FFA Clinic Ophthalmologist Diagnosis Treatable? NO Low Vision Co-ordinator Low Vision Service Rehabilitation Support Social Services Support YES Treatment

13 Key Step 3 STREAMLINING LV SUPPORT & VOLUNTARY NETWORKS Setup a community-based one-stop clinic for LVS with social services who provide rehabilitation support and information for people with sight loss

14 STREAMLINING SUPPORT NETWORKS HES Services COSI LV Co-ordinator Low Vision Service Rehabilitation Support Social Services Support

15 LV Co-ordinator Bridging Hospital and community services Organise the LVC appointments Facilitate onward support service e.g. social workers, ROVI, low vision services, support groups etc Produced Patient Info Pack Providing advice and information Proactive and developmental work

16 Community-based Low Vision Clinic Integrated Low Vision & Rehabilitation Services

17 Integrated LV & Rehab Services One-Stop Service LV assessment: LVA dispensation & education Rehab assessment: ADL Training Kitchen High & low tech LV equipment display Independent living skills course

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24 Results Jan 05 May 06

25 Results: Waiting Times (n=113) Days CO & COSI COSI & HES AMD Clinic & PDT HES & LVS COSI & LVS

26 Referral Time AMD Clinic COSI Referral Time: Wet/Suspect Wet: 8 days Dry: 12 days NON-COSI Referral Time: 42 days

27 COSI vs CO Sensitivity: Specificity: PPV: NPV: TP COST: COSI 94% 63% 60% 94% 0.66 CO 76% 44% 45% 75% 1.23

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29 Hurdles to overcome.. Funding/budget issue Resistance to change Buying in by CO/HES to the Project Compliance with Project protocols Competing commitments/demands On-going audits

30 Top Tips! Knowledge of Prince2 methodology is paramount to give the project a firm and solid start. When more than one organisation are involved in the project, important to ensure that key representatives from each organisation are highly motivated and supportive of the project. Ensure that all board / project steering group / project team members know what is expect of them. Keep the management & clinical team of the Hospital regular informed of the progress of the project especially at the development/initiation stage. Keep line of communication open with all frontline staffs (eg through informal chat, clinic visit etc) to address any of their concerns and to keep them motivated When there are good news to share, make sure that all are informed to keep the team motivated Keep in contact with other PMs by seeking their advice or sharing ideas with them. Avoid reinventing the wheel. Be realistic with the timescale in the project plan Report problems immediately Be generous with commendation to staffs directly involved in the project

31 Conclusions 1 With appropriate baseline & FU training, motivated optoms can improve their skills in triaging AMD Sufficient exposure to AMD to continue develop pattern recognition skill

32 Conclusions 2 Strategically located COSIs in AMD for triaging AMD patients A dedicated AMD assessment clinic with fasttrack referral to PDT treatment clinic for eligible patients A community-based integrated Low Vision and Rehabilitation Clinic which helps to promote greater independence among patients

33 Thank You