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

Abstract

Problem In the Katherine region, Northern Territory, barriers to eye care for Aboriginal and Torres Strait Islander people include unclear eye care referral processes, challenges coordinating patient eye care between various providers, complex socioeconomic determinants and a lengthy outpatient ophthalmology waiting list. Design Mixed methods participatory approach using a regional needs analysis, clinical file audit and stakeholder survey, to develop, implement and monitor quality improvement strategies. Setting Collaboration with Aboriginal Community Controlled Health Services and regional eye care stakeholders in the Katherine region. Key measures for improvement Clinical audit data captured frequency and rates of primary eye checks, ophthalmology referrals and spectacle prescriptions. A survey was developed and applied to assess stakeholder perspectives of regional eye care systems. Strategy for change Quality improvement strategies informed by regional data (clinical audits and survey) included increasing service delivery to match eye care needs, primary eye care training for Aboriginal Community Controlled Health Services staff, updating Aboriginal Community Controlled Health Services primary care templates and forming a regional eye care coalition group. Effects of change Post‐implementation, rates and frequency of recorded optometry examinations, number of spectacles prescribed and rates of annual dilated fundus examinations for patients with diabetes increased. There was a decrease in the number of patients with diabetes who had never had an eye examination. Eye care stakeholders perceived a marked improvement in the effectiveness of the regional eye care system. Lessons learnt Our findings highlight the importance of engaging services and stakeholders to ensure a systems approach that is evidence‐informed, contextually appropriate and reflects commitment to improved eye health outcomes.

Identifying best‐practice features of diabetic retinopathy treatment models for Aboriginal and Torres Strait Islander Australians

“…All seven best-practice features respond to the barriers Indigenous Australians encounter in accessing ophthalmology services. [20][21][22] Respondents' reflections on challenges faced by Indigenous Australians in accessing appropriate specialist care concur with the published literature. The subsequent strategies devised demonstrate the respondents' direct efforts to overcome known barriers and improve access to DR treatment.…”

“…All seven best‐practice features respond to the barriers Indigenous Australians encounter in accessing ophthalmology services 20–22 . Respondents' reflections on challenges faced by Indigenous Australians in accessing appropriate specialist care concur with the published literature.…”

“…Whilst issues surrounding the prevalence and appropriate treatment for Indigenous Australians in other conditions such as mental health and cancer have been well documented 15,16 with recommendations provided on how to assess and treat in a culturally appropriate manner, 17–19 there is no current literature on suitable service delivery models, specific clinical guidelines, or funding models of DR treatment for Indigenous Australians. This is despite the known barriers to accessing ophthalmology in general for Indigenous Australians, including longer waiting times, affordability, unclear referral processes, complex socioeconomic determinants, acceptability of service, and barriers of distance to care 20–22 …”

“…This is despite the known barriers to accessing ophthalmology in general for Indigenous Australians, including longer waiting times, affordability, unclear referral processes, complex socioeconomic determinants, acceptability of service, and barriers of distance to care. [20][21][22] The aim of this study was to identify and consider the features of a best-practice DR service delivery model for Indigenous Australians.…”

Trust, culture and communication: determinants of eye health and care among Indigenous people with diabetes in Australia

“…Participants comprised two groups: Indigenous patients aged 40 years or more with a clinical diagnosis of diabetes, and primary care clinicians working in ACCHS. Purposive sampling using data from a file audit conducted within the ACCHS in each community22 was used to recruit patients. Purposive sampling was also used to recruit clinicians who were involved in primary, chronic disease, or eye care within the ACCHS.…”