Proposed AMD Pathway
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 )
3. Patient attends HES •Access to treatment
•Advice and information etc for patient 4. Fast access to
integrated low vision services •optical low vision
services
•advice and information •counselling
•social service support •rehabilitation •possible certification
(CVI)
Chronic Eye Disease
(AMD)
Management
Brighton & Hove City
GEK ONG
Brighton & Hove
AMD Management Programme
Brighton & Hove City PCT
Brighton & Sussex University Hospital NHS
Trust
Brighton & Hove Social Services
Local Optometrist Committee
Project Aim
“
To develop an
integrated, patient-centred eyecare
service model for patients with
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
3 Key Steps
IMPROVING ACCESS
ENHANCING HES SERVICES
STREAMLINING LOW VISION
SUPPORT & VOLUNTARY
NETWORKS
COSI
AMD Rapid
Assessment Clinic
@ SEH
Low Vision Co-ordinator
PDT Treatment “Wet” or Suspected
“Wet” AMD “Dry”AMD
Low Vision Services
Rehabilitation Support
Social Services Support
GP Other Pathology CO
“Wet” AMD Suspected “Wet” AMD
“Dry” AMD
Other Pathology
Key Step 1
IMPROVING ACCESS
by enhancing the role of community based
optometrists
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
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)
AMD Clinic Ophthalmologist FFA neede d? FFA Clinic Ophthalmologist Diagnosis Treatment Treatable ? YES YES
Low Vision
Co-ordinator
NO NOENHANCING HES SERVICES
Low Vision Service
Rehabilitation Support
Social Services Support
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
STREAMLINING SUPPORT
NETWORKS
LV Co-ordinator
HES Services
HES Services COSICOSI
Low Vision Service
Rehabilitation Support
Social Services Support
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
Community-based
Low Vision Clinic
Integrated Low Vision &
Rehabilitation Services
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
Results
Results: Waiting Times (n=113)
2.6 12.5 4.0 17.8 25.7 0.0 5.0 10.0 15.0 20.0 25.0 30.0 Da ysCO & COSI COSI & HES AMD Clinic & PDT
Referral Time AMD Clinic
• COSI Referral Time:
– Wet/Suspect Wet: 8 days
– Dry: 12 days
COSI vs CO
• Sensitivity:
• Specificity:
• PPV:
• NPV:
• TP COST:
COSI
94%
63%
60%
94%
0.66
CO
76%
44%
45%
75%
1.23
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
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
Conclusions 1
With appropriate baseline & FU training,
motivated optoms can improve their skills in
triaging AMD
Sufficient exposure to AMD to continue
Conclusions 2
Strategically located COSIs in AMD for
triaging AMD patients
A dedicated AMD assessment clinic with
fast-track 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
