Andrea I Boudville

Indigenous access to cataract surgery: an assessment of the barriers and solutions within the Australian health system

Background:  To identify barriers in the health systems that limit access to cataract surgery for Indigenous Australians and present strategies to overcome these barriers.Background:  To identify barriers in the health systems that limit access to cataract surgery for Indigenous Australians and present strategies to overcome these barriers. Design:  Interview and focus group-based qualitative study. Participants:  Five hundred thirty participants were consulted in semi-structured interviews, focus group discussions and stakeholder workshops. Methods:  Semi-structured interviews with a cross-section of health-care professionals, eye care practitioners, primary health-care workers, hospital staff and health department staff were conducted in 21 site locations. Focus group discussions with clients from seven Aboriginal Health Services in Victoria were conducted. Stakeholder workshops included Aboriginal Community Controlled Health sector, eye care sector, government departments and non-government organizations. A total of 279 semi-structured interviews were conducted in the Northern Territory, New South Wales, Queensland, South Australia, Victoria and Western Australia. Three stakeholder workshops were held. Main Outcome Measures:  Barriers and solutions to increase access to cataract surgery for Indigenous Australians. Results:  Analysis of the participant responses identified health system barriers at primary care, specialist care and hospital levels. These included: long waiting times, cost of surgery, complexity of the steps involved in treatment, lack of surgical capacity and low awareness of regional eye health needs. Strategies to overcome these barriers involve a system-wide approach to increase provision and utilization of services. Conclusion:  The need for surgery is real and services need to expand beyond current levels. The solutions for overcoming barriers to cataract surgery could be used as a model for other health interventions which rely on close interaction between primary and specialist care services.

Correcting Indigenous Australians' refractive error and presbyopia.

This paper aims to identify the barriers and solutions for refractive error and presbyopia vision correction for Indigenous Australians.

The roadmap to close the gap for vision—diabetes‐related eye care in the Indigenous Australian population

Blindness from diabetic retinopathy is almost entirely preventable with regular eye examinations and timely laser surgery. The international community through the establishment of Vision 2020 aim to eliminate avoidable blindness worldwide. The Australian community through the establishment of the close the gap to life expectancy are committed to reducing avoidable blindness associated with diabetic retinopathy in the Indigenous population [1,2]. Despite this, limited strategies have been developed to address the alarming discrepancy in blindness from diabetic retinopathy between Indigenous and non-Indigenous populations globally [3]. The aim of this study was to assess the use of eye care services by Indigenous Australians and to explore the barriers to service provision, delivery and utilization and so identify strategies to reduce blindness from diabetic retinopathy. The study included 370 semi-structured interviews from 21 sites within capital cities, and regional and remote areas across Australia. The University of Melbourne Human Research Ethics Committee granted approval for the project. Thematic analysis was undertaken using Nvivo 9 (QSR International, Doncaster, Vic., Australia 2011). Two key themes were identified: health system barriers and patient journey barriers.

Australian Football League clinics promoting health, hygiene and trachoma elimination: the Northern Territory experience

Australia is the only developed country to suffer trachoma and it is only found in remote Indigenous communities. In 2009, trachoma prevalence was 14%, but through screening, treatment and health promotion, rates had fallen to 4% in 2012. More work needs to be done to sustain these declining rates. In 2012, 25% of screened communities still had endemic trachoma and 8% had hyperendemic trachoma. In addition, only 58% of communities had reached clean face targets in children aged 5-9 years. Australian Football League (AFL) players are highly influential role models and the community love of football provides a platform to engage and strengthen community participation in health promotion. The University of Melbourne has partnered with Melbourne Football Club since 2010 to run trachoma football hygiene clinics in the Northern Territory (NT) to raise awareness of the importance of clean faces in order to reduce the spread of trachoma. This activity supports Federal and state government trachoma screening and treatment programs. Between 2010 and 2013, 12 football clinics were held in major towns and remote communities in the NT. Almost 2000 children and adults attended football clinics run by 16 partner organisations. Awareness of the football clinics has grown and has become a media feature in the NT trachoma elimination campaign. The hygiene station featured within the football clinic could be adapted for other events hosted in remote NT community events to add value to the experience and reinforce good holistic health and hygiene messages, as well as encourage interagency collaboration.

Local co-ordination and case management can enhance Indigenous eye care - a qualitative study

BackgroundIndigenous adults suffer six times more blindness than other Australians but 94% of this vision loss is unnecessary being preventable or treatable. We have explored the barriers and solutions to improve Indigenous eye health and proposed significant system changes required to close the gap for Indigenous eye health. This paper aims to identify the local co-ordination and case management requirements necessary to improve eye care for Indigenous Australians.MethodsA qualitative study, using semi-structured interviews, focus groups, stakeholder workshops and meetings was conducted in community, private practice, hospital, non-government organisation and government settings. Data were collected at 21 sites across Australia. Semi-structured interviews were conducted with 289 people working in Indigenous health and eye care; focus group discussions with 81 community members; stakeholder workshops involving 86 individuals; and separate meetings with 75 people. 531 people participated in the consultations. Barriers and issues were identified through thematic analysis and policy solutions developed through iterative consultation.ResultsPoorly co-ordinated eye care services for Indigenous Australians are inefficient and costly and result in poorer outcomes for patients, communities and health care providers. Services are more effective where there is good co-ordination of services and case management of patients along the pathway of care. The establishment of clear pathways of care, development local and regional partnerships to manage services and service providers and the application of sufficient workforce with clear roles and responsibilities have the potential to achieve important improvements in eye care.ConclusionsCo-ordination is a key to close the gap in eye care for Indigenous Australians. Properly co-ordinated care and support along the patient pathway through case management will save money by preventing dropout of patients who haven’t received treatment and a successfully functioning system will encourage more people to enter for care.

Delivery of Eye and Vision Services in Aboriginal and Torres Strait Islander Primary Healthcare Centers

Background Routine eye and vision assessments are vital for the detection and subsequent management of vision loss, which is particularly important for Aboriginal and Torres Strait Islander people who face higher rates of vision loss than other Australians. In order to guide improvements, this paper will describe patterns, variations, and gaps in these eye and vision assessments for Aboriginal and Torres Strait Islander people. Methods Clinical audits from 124 primary healthcare centers (sample size 15,175) from five Australian states and territories were conducted during 2005–2012. Main outcome measure was adherence to current guidelines for delivery of eye and vision assessments to adults with diabetes, those without a diagnosed major chronic disease and children attending primary healthcare centers. Results Overall delivery of recommended eye and vision assessments varied widely between health centers. Of the adults with diabetes, 46% had a visual acuity assessment recorded within the previous 12 months (health center range 0–88%) and 33% had a retinal examination recorded (health center range 0–73%). Of the adults with no diagnosed major chronic disease, 31% had a visual acuity assessment recorded within the previous 2 years (health center range 0–86%) and 13% had received an examination for trichiasis (health center range 0–40%). In children, 49% had a record of a vision assessment (health center range 0–97%) and 25% had a record of an examination for trachoma within the previous 12 months (health center range 0–100%). Conclusion There was considerable range and variation in the recorded delivery of scheduled eye and vision assessments across health centers. Sharing the successful strategies of the better-performing health centers to support focused improvements in key areas of need may increase overall rates of eye examinations, which is important for the timely detection, referral, and treatment of eye conditions affecting Aboriginal and Torres Strait Islander people, especially for those with diabetes.

Establishing the value of Indigenous eye health programs: health needs, economic priority and performance assessment approaches

OBJECTIVES The aim of this paper was to compare three different approaches that are used in support of additional funding of health programs, using Indigenous eye health programs (IEHPs) as an example. These approaches are Heath and Health Care Needs, Economic Priority (Value for Money) and Conformity with Health Services Performance Standards. METHODS A review of relevant literature was conducted to identify relevant benchmarks and assess IEHPs. RESULTS In terms of health needs, vision loss is the fourth highest contributor to the Indigenous health gap. Additional funding for Indigenous eye treatment services to remove the gap is estimated at A

Improving eye care for Indigenous Australians in primary health care settings.

28.1million per annum. As an economic priority, IEHPs (specifically for refractive error, cataract, diabetic retinopathy and trachoma) demonstrate excellent value for money and compare favourably with other better-researched health programs. Evaluation of health performance measures indicated that IEHPs also perform well, as judged by Australian performance standards for health services generally and Indigenous health services more specifically, the later involving local delivery, including care coordination through Aboriginal-controlled community health services. CONCLUSION The value of IEHPs was demonstrated using all three approaches. Different approaches are likely to be more or less persuasive with different audiences. The application of these approaches is relevant to other health programs. WHAT IS KNOWN ABOUT THIS TOPIC? Supporters of additional funding for health programs frequently use the impact of this additional funding on the health and health care needs of the affected populations and individuals. Indigenous Eye Health programs are considered for illustrative purposes. This argument is not necessarily persuasive to funders of health programs. WHAT DOES THIS PAPER ADD? This paper demonstrates that two further approaches, namely Economic Priority and Conformity with Health Performance Measure Standards, both demonstrate good arguments in support of additional funding and that these outcomes may be more persuasive to funders of health programs. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Practitioners are able to harness additional approaches with a higher likelihood of success of submissions for additional funding for the program they are promoting.

Why optometry must work from urban and regional Aboriginal Health Services: Optometry in urban Aboriginal health services

BACKGROUND This paper aims to assess the barriers and solutions to the delivery of eye care in primary care settings and solutions to improve the use of comprehensive eye care among Indigenous Australians. DESIGN, SETTING, PARTICIPANTS Qualitative, mixed method study participants include Aboriginal community members, and health and eye care providers in urban, rural and remote settings. MAIN OUTCOME MEASURES Present evidence for health care providers to better understand and address some of the barriers that limit access to eye care in primary care settings. RESULTS Patient perspectives on barriers to accessing eye care and reasons they choose to seek care or not are presented. Health system barriers identified by health and eye care providers are also presented. Additionally, key enablers for improving access to eye care through primary care services are identified. CONCLUSION Primary health care services have an important role in Indigenous eye health. There is a critical role for primary care in the coordination of the patient journey and cooperating with other services to improve access to comprehensive eye care. Through improved provision of primary eye care, monitoring of Indigenous eye health indicators and supporting patients to access eye care, it is possible to close the gap for vision.

Impact of diabetes on eye care service needs: the National Indigenous Eye Health Survey

The gap in vision and ocular health between Aboriginal and Torres Strait Islander Australians and other Australians continues to be significant, yet three‐quarters of the identified Aboriginal and Torres Strait Islander population live in urban and regional areas of Australia where existing eye‐care services are available. In urban Australia, an improvement in the access and use of eye‐health services is required to provide equitable eye‐care outcomes for Australias Indigenous peoples. Optometric services need to be available within Aboriginal Health Services in urban areas to effectively close the gap for vision.