NHMRC Glaucoma Guidelines - ANZGIG

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA
Chapter 11 – Patient journeys
Interest Group [SEAGIG] 2003). Current models of glaucoma care emphasise co-management
between professional groups and between primary and secondary care sectors. Thus it may be
appropriate to provide profession-specific pathways within companion documents to this guideline,
in conjunction with a multidisciplinary pathway that informs shared-care arrangements.
Creating integrated care pathways
Integrated care pathways differ from simple documented pathways or patient journeys, in that they
combine an explicit evidence-based course of action with a written record of care. Thus how care
is documented, and by whom, is an important element of the pathway. It serves as a visible record
of health care providers’ involvement, with all the related legal implications (Hunter & Segrott
2008). Integrated care pathways for glaucoma involve a number of steps, which are focused on
specific local contexts. These are essential to maximise the translation of national guidelines into
local clinical practice (Campbell et al 1998).
Steps to create integrated care pathways include:
• map out the entire care process as it currently exists in the local context
• identify best practice through examining research evidence and guidelines
• critically review and revise current practice in the light of the evidence
• create pathways that provide avenues for recording variance
• implement the guideline as an active stage of the pathway’s development, in which health care
providers may reshape the document.
The National Health Service in the UK has moved towards outlining integrated care pathways
for glaucoma, in order to align them with national data management. The Glaucoma Clinical
Care Pathway and Dataset represent the clinical information required to manage a patient with
glaucoma along each step of the care pathway, from detection, referral, diagnosis, care planning
and management. The aims are to use the pathway in primary and secondary care and by relevant
health care providers at each step. Its purpose is to document clinical management, and facilitate
transfer of relevant information within, and between, clinical teams to enable consistent and high
quality patient care.
point of note
Care pathways are not a substitute for clinical judgement. They should be recognised as a way
of encouraging the translation of national guidelines into local protocols, and the subsequent
application of local protocols into individual clinical practice.
There are a number of methods by which to achieve the integration of best practice protocols into
clinical practice, of which developing integrated care pathways is one option.
Each proposed patient journey/clinical pathway in these guidelines requires in-depth delineation
of roles and responsibilities of health care providers. These should be sufficiently flexible to
incorporate variations between planned care as agreed by health care providers and professional
bodies, and actual care based on local service arrangements/protocols and service limitations.
It is beyond the scope of this document to provide this refinement.
It should also be noted that other important adjuncts to the ophthalmic care of the patient with
glaucoma may be incorporated in future versions, by including team members such as social
workers and vocational rehabilitation coordinators.
National Health and Medical Research Council 159