Quality of Care and Stakeholders' Perceptions of PEC Implementation in Singapore: A Mixed-Methods Study Protocol.

Purpose: Primary eye care (PEC) model aims to facilitate right-siting of care for patients with stable and non-complex conditions by upskilling optometrists. However, there is 1) a lack of examination on PEC's quality of care (measured as degree of agreement in plan of care between upskilled optometrists and ophthalmologists) and 2) no comprehensive real-world evaluation on operational viability and stakeholders' perception of the community-based PEC model. Holistic evaluation is important as in-depth understanding of stakeholders' experience in implementation will be key to ensure the long-term sustainability and scalability of this PEC model. This study aims to examine the quality of care provided at PEC as well as the contextual factors, strategies, and processes that influence implementation, sustainability, and scalability of PEC.

Methods: This study will adopt a mixed-method sequential explanatory design, guided by the Practical, Robust Implementation and Sustainability Model framework. First, the quality of care will be assessed by examining the degree of agreement between PEC optometrists and ophthalmologists on patients' plan of care. Second, qualitative research design will be employed to understand the experiences of patients and healthcare professionals. In-depth interviews will be conducted with patients and focused group discussions will be conducted with healthcare professionals. Integration of quantitative and qualitative data will be achieved by employing the building and merging approach.

Conclusion: This study will identify areas that could be improved to increase PEC's operational efficiency and enhance its service utilisation. Importantly, key lessons and strategies derived from these evaluations will help to facilitate future nationwide implementation of PEC.