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

Abstract

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.

Using quality improvement strategies to strengthen regional systems for Aboriginal and Torres Strait Islander eye health in the Northern Territory

“…In the Katherine region, key barriers to eye care include complex sociocultural determinants, unclear eye care referral processes, lengthy ophthalmology waiting lists and challenges coordinating patient eye care between various providers, including ACCHSs, hospitals and non‐government organisations . These factors contribute to suboptimal eye care service delivery, resulting in sustained poor eye health outcomes for Aboriginal and Torres Strait Islander people in the region …”

Non‐clinical eye care support for Aboriginal and Torres Strait Islander Australians: a systematic review

“…27,30 Secondary and tertiary eye care coordination included organising and facilitating surgery attendance, booking travel and accommodation for ophthalmic care, and ensuring appropriate follow-up care. 38,41 Key providers of eye care coordination and associated support included eye health coordinators, 11,12,[24][25][26]30,34,35,40,41 Aboriginal Health Workers (AHWs), 23,25,27,34 primary health care staff, 34,38,41 and community liaison staff. 12,23 One study reported that support provided by regional eye health coordinators was intended to cover multiple communities, but in practice was delivered only to the communities where the coordinators resided.…”

“…9 A previous study 10 identified the importance of non-clinical support for Indigenous eye care at the community level, particularly given socio-cultural determinants, such as limited understanding of English, poverty, historical trauma, and racism, that make access to services difficult for Indigenous patients. Eye care coordination involves many non-clinical aspects and is critical for ensuring that patients attend care, 11,12 but specific funding for such activities is limited. 13 Given the need for better and more accessible eye care services for Indigenous Australians, it is important to understand what constitutes non-clinical support and to know who provides it.…”

Increasing the impact of teleophthalmology in Australia: Analysis of structural and economic drivers in a state service

“…4,14,15 Appointing a dedicated coordinator for teleophthalmology should be considered by state health services. This requires coordination of services between GPs, optometrists and ophthalmologists, based on up-to-date knowledge of service providers, regional facilities, IT and administrative support.…”