Attitudes, experiences, and preferences of ophthalmic professionals regarding routine use of patient-reported outcome measures in clinical practice.

BACKGROUND/OBJECTIVES: Routine use of patient-reported outcome measures (PROMs) to assess quality of health care systems is mandated in many countries and has been implemented successfully in many specialities. Ophthalmology currently lags behind. To support and inform future implementation, we investigated paediatric ophthalmic clinicians' experience of, and future training needs for, using child-appropriate vision PROMs and their views about the barriers and enablers to future routine implementation in clinical practice. METHODS: We conducted a pilot study, using an online survey to elicit the experience, attitudes, training needs and perceptions of barriers and enablers to routine PROMs use of ophthalmic health professionals in the Paediatric Ophthalmology Department at Great Ormond Street Hospital, London. A focus-group was undertaken to discuss survey results and preferences regarding presentation of PROM data. Analysis comprised descriptive statistics, presented alongside complementary qualitative data. RESULTS: Eighteen clinicians in the department completed the survey. Twenty-seven took part in the focus group. Clinicians had limited experience of using PROMs but high confidence in the potential positive impact on communication with patients, monitoring chronic conditions and clinical decision-making. Clinicians identified operational issues (collection and analysis of data) and impact (interpretation and application of data) as the two key areas for consideration. Training and information requirements before implementation were clearly articulated, alongside the benefits of using digital/electronic data capture ahead of consultations to allow efficiency and automated analysis, and presentation in an appropriate visual format alongside clinical data to ensure meaningful use. CONCLUSION: The findings of this pilot study of ophthalmic clinicians working in a specialist paediatric ophthalmology department, suggest that ophthalmic clinicians recognise the potential benefits of routine PROMs use in clinical practice. Together with existing literature outside ophthalmology relating to overcoming barriers and exploiting enablers to routine implementation, findings may be applicable in planning routine PROM implementation in paediatric ophthalmology.

AJOE: pasado, presente y futuro. ¿Qué ocurre con los jóvenes oftalmólogos? / AJOE: Past, present and future. What happens to young ophthalmologists?

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Evaluation of the effectiveness of ophthalmic assistants as screeners for glaucoma in North India.

AIM: To assess whether ophthalmic assistants are effective in screening people for glaucoma in India. METHODOLOGY: The study subjects were examined by both trained ophthalmic assistants and an ophthalmologist in both hospital and community settings. Specific tests for the diagnosis of glaucoma suspects included visual field examination using frequency doubling technology perimetry, intraocular pressure measurement (Tonopen), A-scan central anterior chamber depth measurement and dilated optic disc examination. The findings recorded by the ophthalmic assistants were masked to the ophthalmologist to avoid measurement bias. RESULTS: In the hospital setting, there was a substantial level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (89.29%, k=0.7, 95% confidence interval (CI)=0.54-0.86). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was high for sensitivity (95.2%, 95% CI=91.4-97.7%) but lower for specificity at 71.4% (95% CI=60.0-78.7%).In the community setting, there was a moderate level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (78.23%, k=0.50, 95% CI=0.37-0.64). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was moderate for sensitivity (82.9, 95% CI=69.7-91.5%) but lower for specificity at 76.8% (95% CI=72.7-79.5%). CONCLUSION: Ophthalmic assistants can be used for opportunistic case detection of glaucoma suspects in the community. Structured training of the ophthalmic assistants together with enhanced clinical experience would improve their performance in detecting glaucoma suspects in the community.

The Itinerant Surgeon

This term has become tainted among the members of the Ophthalmologcal Society of the West Indies because of the practice of some surgeons who visit the region of not making adequate arrangements for post-operative care, visiting without informing local ophthalmologists and, in some instances, bringing inferior and unsuitable skills. By its nature the practice of ophthalmology requires the use of large amounts of disposable materials that the region cannot always afford. Several international organizations offer help in this regard, but this is often linked to the requirement that their staff should visit and do the surgery. We have to be vigilant that surgeons who are sent by these organizations are adequately trained and licensed and we have to be aware of the surgeon who is seeking further training in our islands. There are many ethical surgeons who visit from time to time to perform surgery and engage in the exchange of skills. They should be welcomed, providing that they are satisfying a need that has been identified by the local surgeons. The visiting surgeons should treat the local fraternity with respect and should leave the local doctors and their patients with their dignity intact. I would further suggest that the term "itinerant surgeon" be dropped from our vocabulary and the term "visiting surgeons" be substituted.(AU)