Biomedical subjects

I C Spencer

Publications and source records attributed to I C Spencer.

6 recordsLinked to original sources

PubMed1999

The Bristol Shared Care Glaucoma Study: reliability of community optometric and hospital eye service test measures.

BACKGROUND/AIMS: Primary open angle glaucoma patients and glaucoma suspects make up a considerable proportion of outpatient ophthalmological attendances and require lifelong review. Community optometrists can be suitably trained for assessment of glaucoma. This randomised controlled trial aims to assess the ability of community optometrists in the monitoring of this group of patients. METHODS: Measures of cup to disc ratio, visual field score, and intraocular pressure were taken by community optometrists, the hospital eye service and a research clinic reference "gold" standard in 405 stable glaucoma patients and ocular hypertensives. Agreement between and within the three centres was assessed using mean differences and intraclass correlation coefficients. Tolerance limits for a change in status at the level of individual pairs of measurements were also calculated. RESULTS: Compared with a research clinic reference standard, measurements made by community optometrists and those made in the routine hospital eye service were similar. Mean measurement differences and variability were similar across all three groups compared for each of the test variables (IOP, cup to disc ratio, and visual field). Overall, the visual field was found to be the most reliable measurement and the cup to disc ratio the least. CONCLUSIONS: Trained community optometrists are able to make reliable measurements of the factors important in the assessment of glaucoma patients and glaucoma suspects. This clinical ability should allow those optometrists with appropriate training to play a role in the monitoring of suitable patients.

Community Health Services↗

PubMed1998

Variability in glaucomatous visual fields: implications for shared care schemes.

The purpose of this study was to establish the extent of variability in the visual fields of patients with glaucoma using a suprathreshold perimetric test strategy. The visual fields of 104 patients (126 eyes) were measured twice, on separate days, with a Henson CFA3000 central visual field analyser. All eyes had a diagnosis of glaucoma and had a minimum of three stimuli missed at 12 dB above their threshold estimate derived at the beginning of the first suprathreshold examination. The perimeter tested 132 locations within the central 25 degrees with a multiple stimulus suprathreshold strategy. Data were analysed on the basis of the difference in the number of recorded missed stimuli between the two visits. Large amounts of variability were found in the visual field results. Variability was largest when all levels of defect were included (> = 5 dB) and was found to be independent of the overall extent of loss. Results from the superior hemifield were found to be more variable than those from the inferior hemifield. The results highlight the problem of differentiating real change in visual field status from the enhanced variability seen in patients with glaucomatous visual field loss. The results from this study can be used to establish return-referral criteria for shared care schemes. The advantages of duplicate measures of the visual field are highlighted.

Glaucoma↗

PubMed1997

The Bristol Shared Care Glaucoma Study--validity of measurements and patient satisfaction.

BACKGROUND: The aims of the study were to determine (1) whether community optometrists are able to make valid measurements of visual parameters in patients with established or suspect primary open angle glaucoma and (2) patient satisfaction with follow-up by community optometrists. METHODS: A randomized study was carried out in the former county of Avon in South West England with patients allocated to follow-up by the hospital eye service or by community optometrists. The subjects were 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria. The main outcome measures were 91) measurements of key visual parameters (intraocular pressure, visual fields and cup/disc ratio) made by hospital eye service and community optometrists, compared with a research clinic reference standard at baseline, and (2) patient satisfaction at baseline and at six months. RESULTS: Community optometrists were able to make measurements of comparable accuracy to those made in the hospital eye service. Patients were significantly more satisfied with a number of aspects of care provided by community optometrists, particularly those relating to waiting times, compared with those from the hospital eye service. CONCLUSIONS: Community optometrists are able to make measurements of key visual parameters in patients with established or suspect primary open angle glaucoma which are of comparable quality to the hospital eye service. Follow-up by community optometrists is acceptable to patients. The costs of each option are reported elsewhere.

Aged↗

PubMed1997

Comparing costs of monitoring glaucoma patients: hospital ophthalmologists versus community optometrists.

OBJECTIVES: To compare the costs of monitoring stable glaucoma patients by community optometrists and hospital ophthalmologists. METHODS: A cost analysis was conducted alongside a randomised controlled trial which compared the accuracy and acceptability of measurement in each form of care. The viewpoints of the health service and of patients were considered. Costs were assessed using a number of different methods. Sensitivity analysis was conducted for key variables. RESULTS: The baseline analysis reflected heavily the different length of time between follow-up in the two arms of the trial (10 months (average) for hospital, 6 months for optometrists). It showed annual cost per patient for hospital ophthalmologists varied from 14.50 pounds to 59.95 pounds, and community optometrist costs varied from 68.98 pounds to 108.98 pounds. Assuming a 6-month follow-up interval for the hospital ophthalmologists, costs varied from 24.16 pounds to 99.92 pounds. CONCLUSIONS: Recommendations about the least costly form of follow-up must depend on the context in which the decision is being taken and the scale of change envisaged. If the aim is to recoup resources from hospitals in order to pay for monitoring in the community, community monitoring is unlikely to be the least costly option.

Community Health Services↗

PubMed1995

The cost of monitoring glaucoma patients by community optometrists.

Glaucoma patients are currently undergoing monitoring by community based optometrists as part of a randomised controlled trial of shared care. As part of this trial, the costs of monitoring these patients by community optometrists are being calculated. Data were obtained from eight practices for the 1993-1994 financial year. The average 'full' cost of a 40 min appointment was calculated as epsilon 31.56 pounds. The average number of unbooked appointments for the month of October 1994 was 16 per practice, which equated to 12, 40 min appointments. Once the number of unbooked appointments was surpassed for each practice, an average opportunity cost of epsilon 54.00 pounds was experienced per appointment. The participating optometrists were willing to accept a minimum fee of epsilon 26.03 pounds for a small number of patient assessments but this rose to epsilon 43.16 pounds for up to 100 glaucoma patients seen per annum.

Community Health Services↗

PubMed1995

The Bristol Shared Care Glaucoma Study: study design.

The purpose of this study was the evaluation of community based optometric monitoring of stable glaucoma patients and glaucoma suspects compared to the routine Hospital Eye Services (HES) monitoring. Four hundred and five subjects were recruited from routine outpatient clinics at the Bristol Eye Hospital. All eligible participants were seen in the routine hospital clinic and then within two months were given a 'Gold Standard Assessment' (GSA) by an independent research team. Participants then visited one of 12 glaucoma-trained optometrists, for a standard battery of tests. Randomisation resulted in 204 subjects being allocated to community care, with reviews on a six monthly basis, with 201 who remained a control group within the hospital. Referral criteria were established to enable optometric detection of apparent glaucomatous progression. A questionnaire was used to assess patient satisfaction with both care types. Additionally a cost analysis exercise was performed.

Community Health Services↗