Same day care in mitigating ‘loss to follow up’

In providing effective eyecare, the risk of ‘loss to follow up’ needs to be mitigated.

At a very basic level this requires consolidation of the patient journey to ensure all relevant clinical assessments occur on the same day wherever possible.

A good example of this is the requirement for functional visual field testing where the patient exhibits risk factors for glaucoma. Practice processes should allow for this to occur on the same day to ensure the optometrist is equipped to make a well-informed decision about patient management in the context of all assessments that have taken place.

This reduces inconvenience, disconnected care and most concerningly, the known risk of loss to follow up that occurs if a patient is required to return for further assessment at a later date.

This is certainly not a new concept in optometry, however it does take a significant mindset shift for optometrists to make it standard practice as opposed to a process enacted on urgent clinical indication only.

Furthermore, an optometrist’s language and explanation of the test requires adaptation, so that it is described as part of the comprehensive work up rather than an additional (potentially perceived as less important) test. Language and explanations need to be coached within clinical teams to ensure same-day solutions become part of standard care.

The logistics of providing holistic care and all necessary additional assessments on the same day are not as simple as they may sound, but to have a truly sustainable model for preventative eyecare the system must work irrespective of patient volume or the unavoidable situations that occur in optometry practice, including human resource issues, diary management constraints and other extenuating circumstances.

As the requirement for additional testing cannot usually be predicted until the patient is already being assessed by the optometrist, processes need to be in place to allow for flexibility in the patient journey and accommodation of additional assessments in a timely manner. This is likely to require readjustment of roles and responsibilities within the clinical support team, strategies to optimise diary management and clear transfer of care between the optometrist and clinical support staff for every patient – all crucial clinical efficiencies.

Throughout the implementation of OCT across Australia and New Zealand, same-day solutions became a significant focus for Specsavers.

The other important aspect of accessibility is optimising access to ophthalmology by referring patients at the right time for tertiary care. This comes down to understanding the various thresholds that exist for different eye conditions. The RANZCO Referral Pathways delineate this clearly and provide guidance on maintaining a consistent approach to referrals. A patient benefits most when their optometrist is well integrated in the entire health care network and able to accurately make decisions on when to monitor and when to refer.