07:17pm Thursday 21 September 2017

Better integration of health services could help patients with visual impairments

The report from researchers at the University of Glasgow and University of Dundee, published in the journal BMC Medicine, calls for better integration of health services for patients with visual impairment.

Dr Helen Court, Research Associate in the Institute of Health and Wellbeing, said: “While our study cannot say whether sight problems cause other conditions or vice-versa, there is a need to give greater consideration to visual impairment when treating patients with multiple other health problems.

“Notably, hypertension (55.6%), coronary heart disease (28.8%) and diabetes (25.9%) were the most prevalent conditions in the visually impaired group, and visual impairment may pose significant barriers to encouraging a healthy lifestyle in this population. 

“Visual impairment may contribute to a compromised diet, due to difficulty in preparing food, increased difficulties engaging in exercise, and high levels of isolation and loneliness. 

“Management of these conditions in patients with visual impairment will require active integration of clinical, social and rehabilitation services, to help improve health.”

The researchers analysed data provided by the Primary Care Clinical Informatics Unit at the University of Aberdeen for all 1,751,841 registered patients who were alive and permanently registered with 314 Scottish general practices on March 31, 2007.

Data on the presence of 29 common chronic physical health conditions, including visual impairment, and eight mental health conditions were extracted. They identified 5,348 – 1.8% of the sample – patients with visual impairment.

They also found that 27 of the 29 physical health conditions and all eight mental health conditions were significantly more likely to be recorded for individuals with visual impairment compared to individuals without visual impairment, after standardising for age, gender and social deprivation. 

Individuals with visual impairment were also significantly more likely to have more comorbid conditions with 95% of individuals with visual impairment having at least one other health problem compared to 84.5% of the control group. Visually impaired people were significantly more likely to have four or five additional health conditions.

The study was part of a programme called ‘Living Well with Multiple Morbidities’ funded by the Chief Scientist’s Office, led by Professor Stewart Mercer under the auspices of the Scottish School of Primary Care.

Dr Court said: “Our study has important implications for clinical practice and for the future design of integrated services to meet the complex needs of patients with visual impairment, such as embedding depression and hearing screening within eye care services.

“We need to think more about how we can help people with visual impairment. We do have some areas in Scotland where low vision services are provided within the community, but provision is patchy.

“For most people hospitals are the main providers of low vision services, but waiting times are too long and for many the distances to hospital are too far. “We need to develop a system across Scotland that is consistent and accessible to everyone regardless of where they live. Our ageing population is only going to get bigger so we need to act now.

“GPs need to take visual impairment into account at the start when dealing with patients as it may directly affect the development or treatment of other conditions. “We know, for instance, that people with visual impairments tend to have higher rates of depression and that it’s one of the biggest issues people with visual impairment face.

“But if someone is depressed, they are less likely to follow the advice of their GP, take medication, or go out and socialise. In Wales, they have been running a trial where they are screening for depression within  low vision appointments.

“We need to see the development of widespread, quality low vision services for people here in Scotland.”

In April, the Scottish Government launched a £2 million sensory impairment strategy which sets out a model care pathway and seven recommendations to ensure individuals and service providers have a clear understanding and expectation of what services are available and will be delivered.


 

Media enquiries: stuart.forsyth@glasgow.ac.uk / 0141 330 4831


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