iCareTrack: measuring the appropriateness of eyecare delivery in Australia

Abstract

Purpose To meet the needs of an ageing population and optimise health expenditure, delivery of care should be based on evidence. However, the level of evidence‐based care delivered to patients with eye conditions is rarely assessed. This study thus aimed to determine the percentage of eyecare encounters at which a sample of adult Australians received appropriate care (i.e., eyecare in line with evidence‐based or consensus‐based guidelines). Methods A cross‐sectional retrospective review of optometry practice records was conducted using random stratified (by state) sampling in mainland Australia. Eighty‐five clinical indicators were developed from evidence‐based clinical practice guideline recommendations and refined by panels of experts using a modified Delphi process. Healthcare records of patients 18 years and over were examined against these indicators, representing appropriate care for three common eye conditions (preventative eyecare, glaucoma, and diabetic eyecare). Encounters occurred in optometry practices that were selected to be representative of the socioeconomic profile of Australian practices. The primary outcome measure was percentage compliance of eyecare delivery against the clinical indicators. Results From 426 optometry practices contacted by mail or telephone, 90 (21%) replied, 46 proved eligible and 42 were included in the study and visited for data collection. From these 1260 patient records were reviewed. Appropriate eyecare was received by Australian patients at an average of 71% (95%CI 70%, 73%) of eligible encounters. The percentage of appropriateness of eyecare at the condition level for preventative, glaucoma and diabetic eyecare was 81% (95%CI 79%, 83%), 63% (95%CI 61%, 64%), and 69% (95%CI 66%, 73%), respectively. Appropriateness of eyecare delivery was lowest for the domains of history taking and physical examination for all eye conditions. Conclusions There were pockets of excellence but consistent delivery of appropriate eyecare needs improvement, and gaps in eyecare delivery should be addressed.

Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework

“…The inclusion criteria were: (1) primary studies of qualitative, quantitative or mixed method design; (2) participants were optometrists or ophthalmic opticians; (3) outcomes included barriers and facilitators to eye care delivery; (4) studies in English; (5) published between 1999 and January 2020. Studies were excluded if: (1) participants were other than optometrists or ophthalmic opticians; (2) outcomes were barriers and facilitators to accessing care; (3) studies on tele-health or shared-care arrangements and (4) studies not related to eye care delivery.…”

Clinical audit as an educative tool for optometrists: an intervention study in age‐related macular degeneration

“…In the field of medicine, audit has been shown to improve clinical record documentation 31,43,44 and patient care 45–49 . However, to our knowledge few studies have assessed the value of clinical audit in eye care 37–39 . In the present study, self‐audit with feedback improved the subsequent documentation of key aspects of AMD care in patient clinical records.…”

“…[45][46][47][48][49] However, to our knowledge few studies have assessed the value of clinical audit in eye care. [37][38][39] In the present study, self-audit with feedback improved the subsequent documentation of key aspects of AMD care in patient clinical records. Studies in various disciplines have investigated audit and feedback as an intervention for optimising patient care.…”

“…36 A recent study measuring the appropriateness of delivery of preventative glaucoma and diabetic eye care in Australia reported low compliance with documenting history taking and clinical examination techniques compared to evidence-based guidelines. 37 Other clinical audit studies, undertaken in the United Kingdom (UK), have analysed optometric practice patterns and management in low vision 38 and glaucoma clinics. 39 However, currently no studies have analysed the optometric care provided to people with, or at risk of, AMD.…”

“…In the context of AMD care provision in Australia, auditing patient records against current best‐practice standards will provide insight into whether optometrists are documenting care consistent with the recommendations in the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) AMD referral pathway 36 . A recent study measuring the appropriateness of delivery of preventative glaucoma and diabetic eye care in Australia reported low compliance with documenting history taking and clinical examination techniques compared to evidence‐based guidelines 37 . Other clinical audit studies, undertaken in the United Kingdom (UK), have analysed optometric practice patterns and management in low vision 38 and glaucoma clinics 39 .…”