PICO questionWhat is the clinical and cost effectiveness of providing glaucoma patients with a ‘glaucoma card’ or individual record of care compared to standard treatment?
Importance to patients or the populationPatient involvement in and understanding of management of glaucoma could reduce stress and uncertainty for patients and potentially improve compliance with medical treatment requirements, with resultant improved outcome i.e. prolonged sighted lifetime.
Relevance to NICEThis could provide evidence of better care in terms of outcome and patient experience. As such future NICE guidance would be in a position to recommend this more patient focused approach to care.
Relevance to the NHSThis could enable a significant increase in cost effectiveness by improving glaucoma management e.g. maximising the effectiveness of topical medical treatment across more patients.
National prioritiesImproving chronic disease management is currently an NHS priority33. This DH policy document specifically identifies “Stratifying patients by risk” and “Aiming to minimise unnecessary visits” as 2 of its key priorities, each of which is relevant to this research question.
Current evidence baseNo RCTs or systematic reviews were identified in our literature review addressing this question.
Study designRandomised controlled trial design with a qualitative component. The latter would be needed to develop both an appropriate intervention and patient focused outcome measure to assess patient experience. A standard visual function (field of vision) test would be appropriate for evaluation of visual outcome.
FeasibilityEthically and technically feasible. The proposed studies would require significant simple size and duration to determine visual outcome with associated cost implications.
Other commentsTime scale to assess useful outcomes would be long, probably 5 years or more.
ImportanceMedium. The research is relevant to the recommendations in the guideline but the research recommendations are not key to future updates. Anything that improves concordance with medications could help prolong a person’s sight.

From: Appendix G, Recommendations for research

Cover of Glaucoma
Glaucoma: Diagnosis and Management of Chronic Open Angle Glaucoma and Ocular Hypertension.
NICE Clinical Guidelines, No. 85.
National Collaborating Centre for Acute Care (UK).
Copyright © 2009, National Collaborating Centre for Acute Care.

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