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SNEC PRIMARY EYECARE CLINIC

Eye conditions such as diabetic retinopathy, glaucoma, and age-related macular degeneration are chronic eye diseases prevalent in the elderly population of Singapore. To provide seamless, integrated team-based model of eye care to elderly patients with these chronic but stable eye diseases, the Primary Eyecare Clinic (PEC) was conceptualized. This opens avenue for providing quality eye care which would be cost-effective, safe and over the long run, easily accessible. 

Right-siting:
In 2013, the first PEC started its operation at SNEC Balestier branch. This follow-up system to right-site patients with stable and mild chronic eye conditions is run by a team of ophthalmic trained physicians and PEC-trained optometrists. They examine, monitor and manage patients with mild and stable diabetic retinopathy, glaucoma and cataract. This potentially would lead to decreased burden of specialist outpatient visits by stable follow-up patients over the long run.

Safe and quality care:
To ensure quality of care, the physicians and optometrists undergo a vigorous six-month structured training by a team of specialist ophthalmologists at SNEC. To facilitate training to deliver clinical assessment and management by these non-ophthalmologists, comprehensive clinical pathways and protocols were developed for the management of these conditions. Clinical skills like detailed history taking, operating the slit-lamp, use of Goldman applanation tonometer, examining the fundus using lenses and indirect ophthalmoscope, as well as interpretation of visual field charts, retinal photos, and optical coherent tomogram images are taught. The candidates undergo evaluation at the end of their training and if they meet all the assessment criteria, they would be accredited to practice at the PEC. They are re-evaluated yearly to ensure their suitability to continue in this role.

To maintain the high level of safety and care for PEC patients, if the eye condition worsened, patient could be referred back to SNEC for urgent attention. To validate safety and efficacy of patient follow-up at PEC, the patients will be scheduled for a review by the specialist ophthalmologists at SNEC every five years. These safeguards ensure that the patient’s care is not compromised although they are managed by non-ophthalmologists.

To assess feasibility and safety of PEC model, research was conducted on a cohort of PEC patients. Phase I research study results have showed that diabetic retinopathy and glaucoma care at PEC was equivalent to that provided at SNEC outpatient clinic managed by ophthalmologists in terms of clinical assessment and management. Patient satisfaction at the PEC was at least as good as at the SNEC outpatient clinics. The research results show that the PEC model provides a safe and effective way for busy tertiary eye centres to right-site patients while maintaining the level of care. 

Expansion of PEC and ease of access:
To facilitate barrier-free eye care for elderly patients, there is a need for ease of accessibility of PEC throughout the island. Progressively more PECs will be set up.

From September 2015, the second PEC will operate from the Diabetes & Metabolism Centre (DMC) at the SGH campus. The DMC is a multi-disciplinary centre that provides one-stop service for patients with diabetes and metabolic conditions. The centre combines clinical care in endocrinology, diabetes, renal medicine, internal medicine, vascular surgery, peritoneal dialysis, podiatry and vitreo-retinal services organised around the needs of the patient. The PEC at DMC will be sited with the SNEC Retina Centre on the second floor.

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