Introducing intermediate-tier services (ITS) such as Minor Eye Conditions Services (MECS) can reduce the volume of hospital referrals by GPs and provide cheaper replacement services at lower costs, new College-funded research has found.
The research, published in the British Medical Journal Open, investigated the changes in volume of hospital ophthalmology patients and the related costs, before and after MECS were introduced in two London boroughs, Lambeth and Lewisham.
In Lambeth, first attendances to hospital ophthalmology referred by GPs were differentially reduced by 30.2 percent at the largest hospital department, compared with control area Southwark. Follow ups fell by 16.7 percent at a second hospital.
For Lewisham, first attendances were reduced by 75.2 percent at the largest provider, compared with Southwark, and by 40.3 percent for follow-up visits.
Total hospital and ITS costs in Lambeth were 2.5 percent higher in the period analysed after MECS was introduced. Total costs in Lewisham were 13.8 percent lower. In comparison, control area Southwark has costs that were 3.1 percent higher.
The majority of Lambeth and Lewisham MECS patients presented with minor anterior eye disease and over 80 percent of these patients were managed by their community optometrist.
Michael Bowen, director of research at the College of Optometrists, said: ‘This is important research, both for the optical sector and beyond; there is very little previous research on the wider effects of introducing schemes such as MECS and the existing pool of data had recommended further investigation into the cost and benefit of these services. The results are encouraging, and suggest that MECS can reduce the volume of patients referred to hospital, and potentially reduce costs.’
Professor John Lawrenson, School of Health Sciences, Division of Optometry & Visual Sciences at City, University of London added: ‘While this research is encouraging, it’s also important to note that it did show up disparities across boroughs. Differences in how services are structured and used may account for the variation in the number of referrals and costs reported between Lambeth and Lewisham. Although not entirely conclusive and not necessarily generisable across the UK, the research fills an important evidence gap on the potential cost-effectiveness of introducing these intermediate tier services.”
The Lambeth scheme was concentrated in eight optometry practices and five practices took part in Lewisham. The number of referrals varied; 56 percent of MECS patients in Lambeth were referred by a GP, in comparison with 75 percent in Lewisham.