Johan Semby Head of Glaucoma Hallands Hospital How to Save More People from Going Blind from Glaucoma –a Swedish Model Johan Semby Head of Glaucoma Hallands Hospital

Glaucoma – a Swedish working model Disclaimer Glaucoma lectures at different ophthalmology departements sponsored by Alcon Glaucoma – a Swedish working model

Glaucoma – a Swedish working model A fight against preventable blindness and visual impairment In Sweden and World Wide Glaucoma – a Swedish working model

Glaucoma – a Swedish working model The three main causes of blindness world wide Glaucoma Cataract Maculadegeneration Glaucoma – a Swedish working model

Glaucoma – a Swedish working model The three main causes of blindness world wide are glaucoma, cataract and maculadegeneration. Glaucoma and diabetes are by far the biggest patient groups within ophthalmology in Sweden, both growing rapidly. Glaucoma – a Swedish working model

Glaucoma – a Swedish working model The three main causes of blindness world wide are glaucoma, cataract and maculadegeneration. Glaucoma and diabites are the biggest patient groups within ophthalmology in Sweden 17% of glaucoma patients goes bilateral blind in Sweden during their life time Glaucoma – a Swedish working model

Glaucoma – a Swedish working model January 2011 – No guidelines for glaucoma in the State of Halland, Sweden Glaucoma – a Swedish working model

Glaucoma – a Swedish working model No guidelines for glaucoma in Halland Judges 21:25 Back in those days, Israel didn't yet have a king, so each person did whatever seemed right in his own opinion. Glaucoma – a Swedish working model

Glaucoma – a Swedish working model 2014 – A government inspection concluded that patients had become visually impaired because of delay in glaucoma follow up at Hollands Hospital. Glaucoma – a Swedish working model

Glaucoma – a Swedish working model 2014 – a government inspection concluded that patients had become visually impaired because of delay in glaucoma follow up at Hollands Hospital. I was asked to address the problem. Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Challenges Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Challenges Glaucoma – no glamour Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Challenges Glaucoma – no glamour Number of doctors / nurses / secretaries Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Challenges Glaucoma – no glamour Number of doctors / nurses / secretaries Resources Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Challenges Glaucoma – no glamour Number of doctors / nurses / secretaries Resources Priorities Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Challenges Glaucoma – no glamour Number of doctors / nurses / secretaries Resources Priorities Logistics Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Logistics – A main problem in causing blindness Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Logistics – a main problem in causing blindness Visual field screening day 1 Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Logistics – a main problem in causing blindness Visual field screening day 1 Doctor evaluate within 1 month (in reality 3-7 months) Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Logistics – a main problem in causing blindness Visual field screening day 1 Doctor evaluate within 1 month (in reality 3-7 months) Secretary writes evaluation within 4 days (in reality 1-2 months) Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Logistics – a main problem in causing blindness Visual field screening day 1 Doctor evaluate within 1 month (in reality 3-7 months) Secretary writes evaluation within 4 days (in reality 1-2 months) Nurse book patients for new visual field (1-7 months delay) Glaucoma – a Swedish working model

Glaucoma – a Swedish working model The patient expects an answer within 1 month In reality a delay of 5 – 15 months Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Solution – Delegation Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Solution – Delegation Let the nurse make a primary evaluation of the visual field Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Solution – Delegation Let the nurse make a primary evaluation If stable (around 80%) nurse tell the patient directly, and rebook directly according to doctors plan or guidelines. Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Solution – Delegation If stable (80%) nurse tell the patient directly, and rebook directly according to doctors plan or guidelines. = no doctor, no secretary, no letters, no phone calls… but a lot of less time and money Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Let the nurse make a primary evaluation = happier patients (answer wright a way) Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Let the nurse make a primary evaluation = happier nurses (no angry phone calls from patients that been waiting 5 months or more) Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Let the nurse make a primary evaluation = happier doctors (much less paperwork) Glaucoma – a Swedish working model

Glaucoma – a Swedish working model … And as a nice side effect: = less visual impairment because of doctors delay Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Is it that easy? Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Is it that easy? It takes a change of heart Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Is it that easy? It takes a change of heart It takes a change of mind Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Is it that easy? It takes a change of heart It takes a change of mind Sometimes it is easier to wonder to the ends of the earth rather then the distans between the mind and the heart Glaucoma – a Swedish working model

Glaucoma – a Swedish working model So what do we need to do? Glaucoma – a Swedish working model

Glaucoma – a Swedish working model So what do we need to do? Motivate nurses Glaucoma – a Swedish working model

Glaucoma – a Swedish working model So what do we need to do? Motivate nurses Train nurses Glaucoma – a Swedish working model

Glaucoma – a Swedish working model So what do we need to do? Motivate nurses Train nurses Create s secure environment for the nurses Glaucoma – a Swedish working model

Glaucoma – a Swedish working model The key to make secure nurses are motivated and supportive doctors that gives clear directions. Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Doctors need to… Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Doctors need to… Be motivated and trained to follow guidelines Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Doctors need to… Be motivated and trained to follow guidelines Establish target pressure Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Doctors need to… Be motivated and trained to follow guidelines Establish target pressure Write follow up plan for each patient that are at higher risk Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Doctors need to… Be motivated and trained to follow guidelines Establish target pressure Write follow up plan for each patient that are at higher risk Define deviation allowed on visual field tests Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Motivate patients Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Motivate patients Glaucoma – More the doctors problem then the patient Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Motivate patients Glaucoma – often more the doctors problem then the patients Inform at nurse level and doctors level Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Priorities We only have this much resources. Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Priorities according to risk profile Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Priorities according to risk profile Delegate to the commercial market those at low risk Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Priorities according to risk profile Delegate to the commercial market those at low risk Make longer time between follow up for low risk patients – so that the high risks always get in time Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Team work Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Team work Engage the whole state Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Team work Engage the whole state All hospitals Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Team work Engage the whole state All hospitals All private clinics Glaucoma – a Swedish working model

Glaucoma – a Swedish working model Team work Engage the whole state All hospitals All private clinics All optrisens / eye shops Glaucoma – a Swedish working model

Right eye - man born1942

Right eye - man born1942

Höger Man f.42