Provision of high-volume low-complexity outpatient care for chronic eye disease in England: what matters to patients

Abstract

Abstract Background The suspension of non-urgent healthcare services due to the COVID-19 pandemic worsened existing ophthalmology backlogs in England (>1 million appointments), adding to the need for new diagnostic service models to provide quicker and accessible services whilst reducing access-related health inequalities. A community-based diagnostic service was developed by Moorfields Eye Hospital NHS Foundation Trust in London, UK, to help clear the backlog for monitoring chronic eye diseases, where tests conducted by trained non-clinical technicians are reviewed remotely by specialist clinicians. This model could set a blueprint for high-volume low-complexity care across the NHS. Previous work has shown that stakeholder engagement and buy-in is key when designing services. This work developed lists of service attributes important to patients when considering routine monitoring for stable eye conditions. Methods A longlist of attributes was developed by reviewing literature and preliminary stakeholder interviews with staff and patients. This was reduced to 12 through discussions in the research team including patient and public involvement collaborators, then a convenience sample of stakeholders was surveyed to rank the attributes. Respondents selected important attributes, and were invited to provide suggestions of possible missed attributes, then ranked the six most important from those they had identified. Responses were analysed as weighted and non-weighted rankings. Results Thirty-one (n=27 patients, n=4 other) analysable responses were received (33% response rate). Attribute ordering differed slightly between weighted and non-weighted rankings but four attributes consistently ranked in the top six: level of expertise of the person conducting the tests, whether results are well explained, accessibility of venue by public transport, and travel time to venue. Lower priority attributes were: how results are stored and passed on, how long it takes to get results, and colocation of other services. Conclusions This study lists important attributes for patients when considering attending routine diagnostic services for monitoring stable chronic eye disease. Consideration of these attributes in service planning could be beneficial to both patients and the NHS, regarding impact of service delivery models on these attributes, and communication and engagement regarding these features with patients and other potential service users.