A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease.

BACKGROUND: Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease. METHODS: The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted. RESULTS: Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non-angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001). CONCLUSIONS: The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities.

Childhood obesity and parental perceptions in a rural Australian population: a pilot study.

AIM: While it has been widely recognised in Australian and overseas studies that parents tend to underestimate the weight of their overweight or obese child, there is an opportunity for further research within rural populations. The aim of this study was to assess the agreement between a parent's perception of their child's weight category and the child's measured body mass index (BMI). METHODS: Cross-sectional pilot study in Dubbo, a large regional centre in western New South Wales in Australia. Ninety-three subjects between the ages of 2 and 17 were recruited from the paediatric inpatient unit of the region's base hospital. Trained nursing staff undertook the anthropometric measurements, while a parent or caregiver was asked to complete a questionnaire assessing their perception of their child's weight category. RESULTS: Thirty-two per cent (30/93) of all parents underestimated the weight category of their child, while only 2% (2/93) of parents overestimated their child's weight category. Overall, 66% (61/93) of parents correctly identified their child's measured weight category. Twenty-nine per cent (27/93) of the sample population was overweight or obese, and in these children, 89% (24/27) of parents underestimated the weight category of their child. CONCLUSION: There is a major discrepancy between the child's measured BMI and their parent's perception of their child's weight category. This finding is consistent with similar past research and has important implications for the management of obesity in children. Further qualitative research may be helpful in ascertaining the reasons for this discrepancy.