Triple bottom line: sustainability in amblyopia care
Sustainability of healthcare is one of the guiding principles of Vision 2020 on the path to eliminating avoidable blindness1 and is actively promoted by the Royal College of Ophthalmologists. Sustainability involves balancing economic, environmental, and social outcomes and demands; this is the 'triple aim divided by the triple bottom line' High value healthcare should incur minimal economic and environmental impact. Previous work has used this framework to evaluate cataract surgery.2,3 Attending hospital eye services (HES) can be difficult for families who often have several children to look after. In the amblyopia treatment pathway, many appointments for amblyopia treatment can safely be provided by orthoptist led clinics. In our setting, protocols allow our HES and the orthoptist led community clinics (CCs) offered by the local community healthcare provider to work seamlessly, so that most amblyopia appointments can take place in CCs. In addition to our regular clinical audits, we aimed to measure the impact of service provision on the 'triple bottom line' We compared the distance families travel to attend the HES (n= 92) and three CCs (n= 71) and the time spent in the clinic (appointment or arrival time to departure time, using the shorter of the two) during one week in November 2015 and one week in March/April 2016. The median distance families travelled to the HES clinic was 6.4 miles (interquartile range IQR 2.5 12.4) and to a CC 3.7 miles (IQR 1.1 5.1) (Figure 1, Table 1) The median time in clinic was 82 min for HES (IQR 55 to 107) and 20 min
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