Fully Funded KESS II MSc by Research Scholarship: Comparing the value of community based and hospital eye service provision of referral refinement and stable patient follow up for patients with wet age-related macular degeneration
Start date: October 2019
*This scholarships is part funded by the Welsh Government’s European Social Fund (ESF) convergence programme for West Wales and the Valleys.*
Wet age-related macular degeneration (wet AMD) is common and causes severe sight loss and blindness. A confirmed diagnosis is required before invasive active disease is treated until it becomes inactive; patients are then monitored regularly in hospital in case the disease reactivates, at which point further treatment is needed. A diagnosis of “suspected” wet AMD made in primary care requires confirmation by an ophthalmologist. If a preliminary diagnosis wet AMD is made, this can cause patients’ considerable concern and if the diagnosis is not confirmed at a Hospital Eye Services (HES) appointment, the worry has been unnecessary and a scarcer HES resource has been consumed that might be more productively utilised by another patient. A referral refinement service should reduce the number of unnecessary referrals into the HES reducing stress for patients and demand for out-patient appointments.
Monitoring is also burdensome to patients, their carers and the HES. Provision of a follow-up service in the community may have considerable benefits to both patients by being local and more flexible and taking the pressure away from the HES.
A recent evaluation of Welsh Government (WG) funded Pathfinder services for wet AMD (1) identified that there is an acute lack of medically trained staff in the HES who participated in the Pathfinder project, especially wet AMD intravitreal injection clinics. Optometrists were upskilled to provide key elements of patient management. Community optometrists in services in two different health boards showed that they can provide a referral refinement service in a community based practice and could monitor stable patients from several practices in collaboration with the HES.
The value of the provision of community based referral refinement and stable follow-up were not evaluated in detail in the evaluation of the pathfinder services as sufficiently detailed data were not available. This MSc by Research project would facilitate a more detailed evaluation of the impact on capacity and the value of substituting optometrists for medically qualified staff in the HES and potential impact on NHS resources. The relative value of the changes, in the context of this research, comprises the impact on patients, NHS health care resources, their costs and visual health outcomes for people who have wet AMD who require care from the NHS.
The methodological approach to the research would be ‘mixed-methods’ combining qualitative research among the stakeholder communities, mapping out patient pathways and contact with community or hospital based services. Quantitative assessments using simple decision analytic modelling based on available data and the literature would be used to assess the potential impact on resources and outcomes of implementing different models of community based care compared with hospital care.
The setting for the research is Hywel Dda Health Board.
Scholarships are collaborative awards with external partners including SMEs and micro companies, as well as public and third sector organisations. The scholarship provides 1 year funding with a 3 month period to complete the thesis. The achievement of a postgraduate skills development award, PSDA, is compulsory for each KESS II scholar and is based on a 40 credit award.