Rachel North Pippa Anderson, Joyce Kenkre, Carolyn Wallace Progress on the Wet Age-Related Macular Degeneration pathfinders service evaluation. Rachel North Pippa Anderson, Joyce Kenkre, Carolyn Wallace

- investing in primary care & community based services Moving care into the community - investing in primary care & community based services - new community services for patients with wAMD

Four different pathfinder services being evaluated Ophthalmic Diagnostic & Treatment Centre Community Hospital Health Park Health Park & Optometric practices

Evaluation of pathfinder services Stakeholder experience – patients, spouses/carers and staff Journey of change – transition to the new service Economic outcome - cost of the new service

Snapshot of findings from questionnaires Stakeholder experience - Patients Snapshot of findings from questionnaires

Questionnaires Total of 284 questionnaires returned to date - Site 1 - 48% Site 2 - 25% Site 3 - 6% Site 4 - 21% Male – 41%, Female – 59% Mean age – 77 years (range 40 to 98 years) Treatment a) ‘Currently receiving regular eye injections’ – 85% b)‘Received regular eye injections and now being monitored’ – 40%

Service provided by reception staff  Very good - 92%, Good – 6%, Fair – 1%, (missing data– 1%) Appointment on time  Yes - 88%, No - 10%, (missing data– 2%)   Enough time with clinic staff  Yes – 96%, No –0. 4% , (missing data– 4%) Importance of seeing eye doctor rather than another member of staff Very important – 58% Quite important – 21% Neither important nor unimportant – 16% Not very important - 3%, Not at all important - 2%

Feel can ask questions and be listened to   Strongly agree – 70%, Agree – 26%, Neither agree nor disagree – 3% (missing data -1%) Given enough information to understand their eye condition   Strongly agree – 60%, Agree – 36%, Neither agree nor disagree – 2% (missing data -1%) Clean and comfortable environment   Strongly agree – 77%, Agree – 20% , Disagree – 1% (missing data –2%) Accessible location/premises Strongly agree – 64% , Agree – 25% , Neither agree nor disagree – 5% , Disagree – 4% , Strongly disagree – 1% (missing data -1%) Overall clinic rating  Very good – 79% , Good – 18%, (missing – 3%)

Emerging themes from ‘additional comments’ section Staff helpfulness ‘Staff very helpful, (G -staff) sat with me today and it helped. Staff are fantastic’ – Site 1 ‘All staff are excellent and the place is brilliant’ – Site 2 ‘I have always found staff very helpful’ – Site 3 ‘Having this condition at quite a young age was very frightening and the staff have always been so supportive and understanding! Cannot thank them enough’ – Site 4

Location of clinic ‘I'd like to keep coming here as it is close to home’ – Site 2 ‘I feel an eye clinic setting is preferable to a hospital setting. Seems calmer and more organised and easier to speak to the relevant staff. Feel less stressed. The procedure is very unpleasant and therefore a more pleasant and calming setting certainly helps’ – Site 1 Satisfaction with service/treatment ‘I feel very fortunate that my treatment is in such good hands’ – Site 3 ‘Everyone always do their best to be helpful’ – Site 4

Snapshot of cross cutting themes from stakeholder perspectives Staff focus groups Patient & spouse/carer interviews

Stakeholder interviews Emerging themes based on transcripts from – 4 Focus groups with staff 6 patients only & 2 patient & spouse interviews

1. Key/Central figures There are individuals who are a central focal point, flexible communicators who coordinate multiple processes, interface with other departments and take time with the patient/spouse. Role described as ‘a complete and utter balancing act’.(FG4) - key decision makers about clinical process and competence, initiating confidence in practitioners and patients. - visionary, always considering ways in which to improve and expand the service. - there is a disruption to the service when these individuals are away on short or long periods of leave.

2. Environment & atmosphere Patients and spouses expressed that the new community settings in comparison with the previous hospital settings - reduced their anxiety about an unpleasant procedure provided a calm and cared for environment they felt safe it was a less daunting journey had better parking and access less clinical and more personal

‘ Staff feel ‘big difference’ between hospital and community. It is a calmer more controlled environment, ‘able to get on with things and focus on the patient’. ‘Yeah, I find it rewarding doing this clinic, and you’re away from hospitals, so you’re away from those pressures, and you do get to know them, you’re seeing them every five weeks, you get to know your patients’. (FG1)

3. Anxious Waiting Patients at three out of four sites don’t receive their next appointment the same day as their treatment. This causes patient and spouse anxiety, uncertainty, lack of confidence and fear of loss of sight.

4. Transitioning to a new sustainable service Staff identified a number of challenges and considerations to transitioning from one clinical setting to another - persuading patients to change - protecting time for updating data bases training, standard operating procedures, ‘formalising capability’ discharge process treatment length expanding their knowledge of the hospital or community setting.

5. Staff Motivation Staff were motivated to participate in this service change for a number of reasons including - commitment to improve the patient experience and make a difference personal development of additional skills enhanced role satisfaction.

6. Patient motivation Patients and spouse are motivated to continue with their treatment plans at any cost. They will travel, endure anxiety/discomfort and lengthy treatment plans to preserve sight and independence. ‘I’m still working. I use my sight like most people need their sight, I know that, but I don’t want to loose any more, other than that I need my sight because I restore musical instruments. I need... I’m in my middle seventies but I don’t intend retiring. We’re a fairly active family as well, we like walking, so I want to keep my sight as long as I can’ (P2).

Thank you for your attention Team - Rachel North Pippa Anderson Joyce Kenkre Carolyn Wallace Sarah Wallace Samantha Groves