Zhen Ling Teo, Louis Tong
In rapidly aging populations, the increasing prevalence of chronic diseases represents the biggest challenge of modern health care. Many interventions have been performed worldwide to encourage the integration of primary care and specialised services for the treatment of chronic diseases traditionally managed by specialists. Such interventions have been recently reviewed, and are found to vary in value and cost effectiveness. An example of a 'specialised chronic disease' is dry eye, also known as Keratoconjunctivitis sicca. In this article, we will propose specific interventions in dry eye at the primary-secondary care interface, based on evidence seen in other health conditions. 'Integration' does not aim to physically relocate a specialised clinic into the community. Instead, it is characterized by the interaction between a specialist and a team of community carers who perform secondary care, or the care of post-hospital discharge patients. Community carers may include general practitioners with a special interest in dry eye, optometrists, psychologists, nurses or social workers. Professional and patient behavioural changes are also critical for healthcare integration. With the use of specific effective measures, the integration of specialist and community healthcare services can provide holistic, efficient and affordable care.
