A study into referrals made by community optometrists to the hospital eye service in England and Scotland has been conducted by researchers at City, University of London.
It assessed communication pathways against established standards and calculated referral rate and referral reply rate as a measure. It found variable standard of referrals and deficits in replies to community optometrists.
Lead researcher Rakhee Shah told Optician: ‘We were looking at referrals and whether referrals are being made to the appropriate professional, whether the referral was necessary and whether it was accurate. We were looking at different elements of it, but, ultimately, the overarching objective and focus was communication between primary and secondary care.’
During the study, three centres in each country aimed to assess 150 referrals per practice and hospital eye service setting, which resulted in 905 referrals overall.
Shah said: ‘We had a range of referral rates and referral reply rates in England and Scotland. In England, the referral rate at the higher end was 8.7 and 3.6 at its lowest. In Scotland, with one location, we had a low one of 2.6 but then the other two were 7.’
The range of the referral rates in England and Scotland were fairly similar but Shah suggested Scotland’s could be fractionally lower because of the way NHS general ophthalmic services (GOS) work. As practitioners in Scotland saw patients for follow-ups because of GOS funding, they were perhaps able to fine tune their referral before it went to secondary care. Whereas in England, practices were not reimbursed for additional visits and were perhaps more inclined to refer. ‘That could be one of the reasons,’ she said.
‘Practices in Scotland, generally, had a higher referral reply rate compared to those in England overall.’ Shah added there was one example in Scotland where the reply rate was exceptionally high at 83.7%.
A close relationship between primary and secondary care was found in that example in Scotland where the referral rate was
particularly high. Systems of communication included phoning patients through to the hospital to confirm diagnosis and WhatsApp groups so optometrists could check with ophthalmologists if the referral was necessary.
‘We had good data in England as well, where 41%, 48%, 50% referral reply rate is pretty good.’
Shah explained the study could be broadened to investigate Wales and more assessment could be carried out nationally, plus finding out how the introduction of electronic referrals has worked.
In order to improve referral reply rates, Shah said the feedback loop needs to be closed because professionals could only learn about when they were over-referring if the ophthalmologist provided information.
‘If the ophthalmologist doesn’t write back to them, there’s no way of the optometrist knowing whether the reason for referral has been addressed and whether the patient was seen at the hospital. And, to me, whether the optometrist’s provisional diagnosis was right. What we found is that optometrists in England and Scotland were grateful for their feedback because they took it as a kind of CPD and learning,’ she concluded.
The paper was available online at Eye. https://www.nature.com/articles/s41433-021-01728-2.