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Ophthalmology
Research
Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service
  1. Thomas Mason1,
  2. Cheryl Jones1,
  3. Matt Sutton1,
  4. Evgenia Konstantakopoulou2,3,4,
  5. David F Edgar2,
  6. Robert A Harper5,
  7. Stephen Birch1,6,
  8. John G Lawrenson2
  1. 1 Manchester Centre for Health Economics, University of Manchester, Manchester, UK
  2. 2 Division of Optometry and Visual Science, Applied Vision Research Centre, University of London, London, UK
  3. 3 NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  4. 4 Institute of Ophthalmology, University College London, London, UK
  5. 5 Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester, UK
  6. 6 Department of Clinical Epidemiology and Biostatistics and Centre for Health Economics and Policy Analysis, McMaster University, Ontario, Canada
  1. Correspondence to Thomas Mason; thomas.mason{at}manchester.ac.uk

Abstract

Objective This research aims to evaluate the wider health system effects of the introduction of an intermediate-tier service for eye care.

Setting This research employs the Minor Eye Conditions Scheme (MECS), an intermediate-tier eye care service introduced in two London boroughs, Lewisham and Lambeth, in April 2013.

Design Retrospective difference-in-differences analysis comparing changes over time in service use and costs between April 2011 and October 2014 in two commissioning areas that introduced an intermediate-tier service programme with changes in a neighbouring area that did not introduce the programme.

Data sources MECS audit data; unit costs for MECS visits; volumes of first and follow-up outpatient attendances to hospital ophthalmology; the national schedule of reference costs.

Main outcome measures Volumes and costs of patients treated.

Results In one intervention area (Lewisham), general practitioner (GP) referrals to hospital ophthalmology decreased differentially by 75.2% (95% CI −0.918% to −0.587%) for first attendances, and by 40.3% for follow-ups (95% CI −0.489% to −0.316%). GP referrals to hospital ophthalmology decreased differentially by 30.2% (95% CI −0.468% to −0.137%) for first attendances in the other intervention area (Lambeth). Costs increased by 3.1% in the comparison area between 2011/2012 and 2013/2014. Over the same period, costs increased by less (2.5%) in one intervention area and fell by 13.8% in the other intervention area.

Conclusions Intermediate-tier services based in the community could potentially reduce volumes of patients referred to hospitals by GPs and provide replacement services at lower unit costs.

  • Organisation
  • intermediate-tier services
  • need
  • supply
  • eye-care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-014089

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    Footnotes

    • Contributors The analysis and interpretation of the data were undertaken by MS, TM, CJ and SB. The paper was drafted by CJ and TM. All authors contributed to the design of the study and approved the final version of the paper.

    • Funding Thisresearch was funded by the College of Optometrists.

    • Disclaimer The views expressed are the authors’ sole responsibility.

    • Competing interests None declared.

    • Ethics approval The study was approved by the Research and Ethics Committee of the School of Health Sciences, City University London and followed the principles of the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data used in this study are not publicly available with the exception of the cost data.