ORCID

Abstract

Objectives This process evaluation explores patient and healthcare professional acceptability of community-based monitoring versus hospital-based care for patients with quiescent neovascular age-related macular degeneration (QnAMD). Design Qualitative process evaluation was conducted as part of a randomised controlled trial. Setting Six hospitals and six community-based practices. Participants 25 patients and 16 healthcare professionals (ophthalmologists and optometrists). This approach helped differentiate between common issues and those specific to community-based monitoring. Intervention The Quality-Assured Follow-Up of QnAMD by non-medical practitioners trial aimed to examine whether non-medical practitioners follow-up patients with QnAMD in the community in a safe and clinically and cost-effective way. The process evaluation aimed to examine whether the intervention was acceptable by patients and professionals. The process evaluation was based on interviews which contained open-ended questions focused on patient experience and confidence in community-based care, issues concerning the practicalities of the organisation and management of the clinic, and resources including IT and digital equipment. The theory of acceptability framework was used to interpret the findings. Results Patients reported positively on the experience of receiving QnAMD services in the community and highlighted staff professionalism and clear communication. Key themes were the proximity of care provision for patients, IT interoperability and the real-world costs of running the service. Some patients randomised to the hospital showed preference for the intervention to take place in the hospital, mediated mainly by prior experience of hospital care and travel distance. The location of the clinic and transport routes affected the experience of attending appointments, with strong preference expressed for proximity to one’s home. Inaccessibility due to non-modifiable internal building structures in the community and parking in hospital eye services was reported by a small proportion of patients. Healthcare professionals reported positively about their ability to deliver QnAMD services in community settings but raised concerns about the compatibility of technological infrastructure that facilitates the sharing of optical coherence tomography image and video files. Some optometrists were also concerned about the financial sustainability of the intervention after the end of the trial due to the costs involved in the administration of QnAMD follow-up care. Conclusions The delivery of QnAMD services in the community by non-medical personnel was broadly accepted by both patients and practitioners. This implies that nonmedical practitioners can follow up patients with QnAMD in the community in a safe way. Further research would be needed to establish whether similar results would be obtained during routine practice outside a research project and whether the long-term follow-up for QnAMD would be financially sustainable for independent as well as chain community optometry practices.

Publication Date

2026-02-04

Publication Title

BMJ Open

Volume

16

Issue

2

ISSN

2044-6055

Acceptance Date

2026-01-18

Deposit Date

2026-02-27

Funding

This work was supported by the National Institute for Health Research, Award ID: 17/85/05. We would like to thank Professor Heather Waterman andProfessor Molly Courtenay for their contributions to this study before they retired.

Keywords

Clinical Trial, GERIATRIC MEDICINE, OPHTHALMOLOGY, QUALITATIVE RESEARCH, SOCIAL MEDICINE, Attitude of Health Personnel, Humans, Macular Degeneration/therapy, Middle Aged, Male, Patient Satisfaction, Hospitals, Patient Acceptance of Health Care, Health Services Accessibility, Aged, 80 and over, Female, Aged, Qualitative Research, Community Health Services

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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