Glaucoma-service provision in Scotland: introduction and need for Scottish Intercollegiate Guidelines Network guidelines

Abstract

Andreas Syrogiannis,1 Alan P Rotchford,2 Pankaj Kumar Agarwal,1 Manjula Kumarasamy,1 Donald Montgomery,1 Jennifer Burr,1 Roshini Sanders1,2 On behalf of the SIGN working group 1SIGN Working Group, SIGN Guidelines for Glaucoma Referral and Safe Discharge, 2Healthcare Improvement Scotland, Edinburgh, Scotland Purpose: To describe the pattern of glaucoma-service delivery in Scotland and identify areas for improvement, taking into account Scottish General Ophthalmic Services (GOS) arrangements and the Eye Care Integration project, and to design Scottish Intercollegiate Guidelines Network (SIGN) guidelines to refine the primary and secondary interface of glaucoma care.Materials and methods: A glaucoma-survey questionnaire was sent to all consultant glaucomatologists in Scotland. The design of SIGN guidelines was based on the results of the questionnaire using SIGN methodology.Results: Over 90% of Scottish glaucoma care is triaged and delivered within hospital services. Despite GOS referral, information is variable. There are no consistent discharge practices to the community. These results led to defined research questions that were answered, thus formulating the content of the SIGN guidelines. The guideline covers the assessment of patients in primary care, referral criteria to hospital, discharge criteria from hospital to community, and monitoring of patients at risk of glaucoma.Conclusion: With increasing age and limitations to hospital resources, refining glaucoma pathways between primary and secondary care has become a necessity. Scotland has unique eye care arrangements with both the GOS and Eye Care Integration project. It is hoped that implementation of SIGN guidelines will identify glaucoma at the earliest opportunity and reduce the rate of false-positive referrals to hospital. Keywords: glaucoma, referral, community care, SIGN guidelines