NHMRC Glaucoma Guidelines - ANZGIG

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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
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 11 – Patient journeys Patient pathways in open angle glaucoma Figure 11.1 presents the current best evidence for the most appropriate care of the ‘average’ patient with open angle glaucoma. There are many factors which impact on the decision-making of the different health care providers who are responsible for the management of individual patients. Glaucoma is a complex group of diseases, which often occurs in older individuals with comorbid conditions. These may impact upon the choice and effectiveness of available treatment options. It is beyond the scope of the proposed patient pathway to incorporate wider aspects of a patient journey with glaucoma, for instance social, emotional and economic elements. In all stages, it is important that appropriate support is provided by health care providers to the patient with glaucoma and their carer(s). This may be provided by ensuring links to important consumer groups such as Glaucoma Australia (refer to Chapter 12) and by clear written and verbal communication. In advanced stages, low vision rehabilitation is a valuable adjunct to the glaucoma management plan. Patient pathways in angle closure glaucoma Figure 11.2 represents the current best evidence for the most appropriate care of the ‘average’ patient with intermittent or chronic angle closure. Angle closure may present as an acute crisis, requiring emergency management. These guidelines provide clear information regarding the signs and symptoms of an angle closure crisis. 160 National Health and Medical Research Council
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NHMRC Glaucoma Guidelines - ANZGIG

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