Primary Vision Care Program

Background: Although data in Portugal are still limited, experience highlights that people might go blind due to lack of access to hospital care on time.

Approach: The Local Health Unit of Alto Minho (LHUAM) serves a population of 245 thousand inhabitants spread over 2255 km2, with a high geographic dispersion. It’s an aging population, inserted in a rural context, economically deprived, with a high rate of illiteracy. Our Ophthalmology department is the only public system unit delivering ophthalmic care in the hole district. 

Some people do not come to our hospital because there are no public transportation available or they simply can’t afford it. People tend to come only when their clinical condition is so serious there is nothing that can be done. 

We implemented a Primary Vision Care Program in a primary care unit, 50km away from the hospital, that covers the northern part of the district, the neediest population.

The program has 3 lines of integrated activity:

1. In-person Ophthalmological appointments: We redefine our referral algorithm to correctly identify the patients that can be observed in the primary care unit and those that had to be referred to our hospital. All cases were classified as efficiency if they didn’t need to finish their evaluation at the hospital to, or as entropy if they did.
2. Screening of blinding leading diseases: The screened diseases are Glaucoma and Age related Macular Degeneration (AMD). Patients are elected for screening at 60 years old. Tests are performed by orthoptists and analyzed remotely by ophthalmologists. Positive screenings are referred to observation.
3. Remote surveillance of chronic diseases: Also performed by orthoptist. Complementary tests performed at the primary care unit that are remotely analyzed by ophthalmologists.

Results:

The program started on January 2023, and is currently the only primary care unit with Ophthalmology appointments in Portugal. In the first year of activity:

1122 patients triaged: 91% had their consultations at the primary care unit, 9% at the Hospital. 1021 First Consultations Performed: 96% classified as Efficiency, 4% as Entropy. 1223 decentralized appointments. 115 314 km avoided. 120 satisfaction surveys: 97% Very Satisfied, 3% Satisfied.

Regarding the impact for patients, the program resulted in a 75% reduction of hospital visits and associated costs, in our biggest group of patients. Our second and third biggest groups now get their treatment at the primary care unit.

All eligible patients were invited for screening until the end of the year. 6,5% of 174 screened patients were referred to consultation.

The remote surveillance of chronic disease started in October 2024: At the moment 34 patients are in the program.

Implications: The next step is to implement the platform in a second primary care unit that provides services to the inland part of the district. In many  countries, patients struggle for differentiated healthcare. Unfortunately, this usually results in irreversible health losses. Integrated care is the solution. Health organizations need to reorganize themselves and find new ways to reach to these patients, before it’s to late.