CONCEPT OF REGIONAL OPHTHALMOLOGICAL PATIENT PATHWAY: FLOW MODELING, BOTTLENECK IDENTIFICATION AND OPTIMIZATION PROPOSALS

Abstract

Introduction. Organization of rational patient pathways within ophthalmological care system represents an urgent problem of modern healthcare requiring systematic approach to coordination between different levels of medical service delivery. Ophthalmology constitutes one of the most burdened outpatient specialties, forming nearly one-tenth of total waiting lists for outpatient services in secondary care. Prolonged waiting times for consultations and patient loss between care levels lead to untimely diagnosis of ocular diseases and deteriorated treatment prognosis. The aim of the study is to substantiate conceptual model of regional ophthalmological patient pathway through analysis of international experience in organizing multilevel ophthalmological care systems, identifying critical bottlenecks in patient flows and developing evidence- based proposals for system optimization. The methodological section employs systematic approach using bibliosemantic method for analyzing scientific publications in Scopus, Web of Science and PubMed databases for 2020-2024, content analysis of international models of ophthalmological service organization, comparative analysis of patient routing systems in countries with different healthcare development levels and modeling method for organizational mechanisms of coordination between ophthalmological care provision levels. The main material presentation characterizes current state of ophthalmological services organization, analyzes international experience in building integrated ophthalmological care systems, systematizes typical bottlenecks in patient pathways including insufficient coordination between levels, prolonged waiting times for specialized care, duplication of diagnostic procedures, limited access to telemedicine consultations. A conceptual model of regional ophthalmological pathway is presented with definition of each level's functions, patient referral criteria, coordination mechanisms and system effectiveness monitoring. Conclusions substantiate necessity of creating integrated regional ophthalmological care system with clear coordination between primary, secondary and tertiary levels, implementing electronic patient referral systems, utilizing telemedicine technologies for preliminary triage and consultations, standardizing routing criteria and establishing quality and accessibility monitoring system for ophthalmological care.