Enhancing vision care integration: 1. Development of practice algorithms

Background: Appropriate access to the best quality of vision care is enhanced when patients receive eye care services from the right professional, at the right time, and in the right place. This paper, the first in a two-part series, describes the development of an integrated framework for vision care delivery. Specifically, two patient-centred vision care algorithms for the multidisciplinary management of diabetic retinopathy and the red eye are outlined, and the process that resulted in their development is described. Methods: The method used relies on a description of a multidisciplinary collaboration that occurred among ophthalmologists, optometrists, general practitioners and representatives of the Nova Scotia Department of Health with the aim of developing an integrated patient-focused multidisciplinary framework for vision care delivery. Results: The process of collaborative negotiation among the four groups resulted in the development of multidisciplinary algorithms for the screening of patients with diabetes mellitus and the treatment of those presenting with a red eye. Interpretation: Professional scope of practice has always been a contentious issue among health care prpfessions. However, where parties agree to work within an atmosphere of respect and to accept guidance in areas of disagreement from a third party respected by all, compromise is possible. The result was the development of two vision care algorithms and ongoing efforts on the development of other algorithms.