Suchergebnisse

The COVID-19 pandemic resulted in changes to low vision service provision across the UK. The main aim of this study was to investigate service providers' (SPs) experiences of, and views on, the impact of the COVID-19 pandemic on provision of low vision (LV) assessments, and future provision post-pandemic. A mixed methods approach employed two surveys (S1 and S2) and one-to-one semi-structured phone interviews. SPs were invited for S1 (LV assessments before and during the pandemic) between June and August 2021, and S2 (post-pandemic services) in July 2022. Eleven purposively recruited SPs gave telephone interviews, assessing changes to LV assessments during the pandemic and how experiences could inform future services. Survey responses were tested for significant differences between proportions, and interviews analysed using thematic analysis. Eighty SPs, comprising clinical and non-clinical professionals, responded to S1, 27 to S2. Two themes emerged from interviews and surveys: early pandemic modifications and remote services. From S1, during the pandemic there was a significant increase ( p < .001) in the proportion of SPs providing LV assessments remotely (either alongside face-to-face provision, or remotely only), compared with pre-pandemic. S1, conducted while some COVID restrictions remained, also identified an increase in the proportion of LV assessments expected to be provided remotely post-pandemic compared with pre-pandemic ( p < .001). However, for S2, conducted after all restrictions were lifted, the increase in the proportion of LV assessments actually provided remotely post-pandemic was not statistically significant ( p = .20). Advantages (e.g., reduced risk of infection) and limitations (e.g., issues for hearing-impaired users) of remote LV assessments were highlighted. Remote LV assessments increased significantly during the pandemic and remained more common post- than pre-pandemic, though less common than anticipated. Many advantages were perceived, but guidance may need to be developed before remote services are more widely adopted.

PURPOSE: UK demographic and legislative changes combined with increasing burdens on National Health Service manpower and budgets have led to extended roles for community optometrists providing locally-commissioned enhanced optometric services (EOS). This realist review's objectives were to develop programme theories that implicitly or explicitly explain quality outcomes for eye care provided by optometrists via EOS and to test these theories by investigating the effectiveness of services for cataract, glaucoma, and primary eye care. METHODS: The review protocol was published on PROSPERO, and RAMESES publication standards were followed. Programme theories were formulated via scoping literature searches and expert consultation. The searching process involved all relevant electronic databases and grey literature, without restrictions on study design. Data synthesis focussed on questioning the integrity of each theory by considering supportive and refuting evidence from the source literature. RESULTS: Good evidence exists for cataract, glaucoma and primary eye care EOS that: with appropriate training, accredited optometrists manage patients commensurate with usual care standards; genuine partnerships can exist between community and hospital providers for cataract and glaucoma EOS; patient satisfaction with all three types of service is high; cost-effectiveness of services is unproven for cataract and primary eye care, while glaucoma EOS cost-effectiveness depends on service type; contextual factors may influence service success. CONCLUSIONS: The EOS reviewed are clinically effective and provide patient satisfaction but limited data is available on cost-effectiveness.