Development of an integrated adult eye care service between a tertiary eye hospital and a community eye clinic the Dublin experience.

The Sláintecare Integration Fund awarded funding to 122 Irish healthcare projects in 2019 with the aim of establishing the building blocks for a significant shift in the way in which health services are delivered in Ireland. As a result of a submission by the Clinical Programme for Ophthalmology and Community Healthcare Organisation (CHO7) funding was awarded to establish a community based adult ophthalmology service in Tallaght in South West Dublin. CHO7 has a population of more than 700,000 and provides healthcare in the community for south & south west Dublin, Kildare and west Wicklow. Prior to the development of this service adult eye care for this area was hospital based delivered in either the Royal Victoria Eye or Ear Hospital (RVEEH) or associated linked hospitals in South Dublin. The service was developed in response to increasing waiting lists for new and review patients with chronic eye disease in RVEEH and followed the recommendations of the Primary Care Eye Services Review Group1. The emphasis was on providing a service for cataract, glaucoma and medical retina. The community clinic is located in a primary care centre in Tallaght in South West Dublin and the service is delivered by the Primary Care Eye team comprising a Consultant Ophthalmologist, Optometrist, Ophthalmic nurses and an administration team. The community service is integrated with RVEEH with integration of IT systems including MediSIGHT (electronic patient record), Zeiss Forum (image platform), Docman (document management) and CAPAS (patient administration system) to allow patients and their information to move seamlessly between sites. There is an overarching joint governance group with senior management and clinical representation from CHO7 and RVEEH. Working groups with representation from both organisations have been established to develop administrative, IT and clinical pathways across the service. Initial service delivery was to address the new patient cataract waiting list with waiting times of 4-5 years for a routine appointment in RVEEH. Patients have a virtual consultation by telephone or video prior to the face to face appointment. For those listed for surgery a pre-assessment is conducted on the same day by the Ophthalmic Nurse and the Optometrists and the post-op care is delivered in the community clinic by the Optometrists under the supervision of the Consultant Medical Ophthalmologist following a period of training and a competency assessment. Service delivery commenced in May 2021 but was significantly impacted by a cyber-attack on the Irish health services until September 2021. To date 839 appointments have been offered in the cataract service with 232 listed for surgery. Glaucoma assessment clinics have commenced. These are delivered by the Optometrists with virtual review of clinical and imaging information by the Consultant Medical Ophthalmologist. This model was developed by the RVEEH glaucoma service and patients from the CHO7 catchment area can transfer to the community service creating extra capacity at RVEEH. This service is also being offered to stable glaucoma patients that are overdue for review as a result of the Covid 19 pandemic. [ABSTRACT FROM AUTHOR]