The burden of acute eye conditions on different healthcare providers: a retrospective population-based study

Abstract

Background: The demand for acute eyecare exponentially outstrips capacity. Public awareness of community eyecare services is lacking. Aim: We primarily aimed to quantify the burden of acute eyecare on different healthcare service providers in a national population through prescribing and medicines provision by GPs, optometrists and pharmacists and provision of care by Accident and Emergency (A&E) services. We further aimed to characterise some of the drivers of this burden. Design&Setting: Retrospective data-linkage study set in Wales,UK. Method: Analysis of datasets from the Secure Anonymised Information Linkage (SAIL) Databank (GP and A&E), the ‘Eye Health Examination Wales’ service (optometry) and the ‘Common Ailments Scheme’ (pharmacy), during 2017-2018. Results: We identified 65.4 episodes of care per-1,000-people-per-year, a GP prescribing rate of 0.9% and an A&E attendance rate of 0.6%. Optometrists and pharmacists managed 51.8% and 0.6% of all episodes respectively. Older females and infants of both sexes were more likely to use GP prescribing services, while adolescent and middle-aged males were more likely to visit A&E. GP prescribing burden was driven partially by economic deprivation, access to services and health score. Season, day-of-the-week and time-of-day were predictors of burden in GP and A&E. Conclusions: Acute eyecare continues to place considerable burden on GP and A&E services in Wales, particularly in urban areas with greater economic deprivation and lower overall health. This is likely to increase with a rapidly ageing population. With ongoing pathway development to better utilise optometry and pharmacy and improved public awareness, there may be scope to change this trajectory.