Access to eye health services among indigenous Australians: an area level analysis

Abstract

BackgroundThis project is a community-level study of equity of access to eye health services for Indigenous Australians.MethodsThe project used data on eye health services from multiple sources including Medicare Australia, inpatient and outpatient data and the National Indigenous Eye Health Survey.The analysis focused on the extent to which access to eye health services varied at an area level according to the proportion of the population that was Indigenous (very low = 0-1.0%, low = 1.1-3.0%, low medium = 3.1-6.0%, high medium = 6.1-10.0%, high = 10.1-20.0%, very high = 20 + %). The analysis of health service utilisation also took into account age, remoteness and the Socioeconomic Indices for Areas (SEIFA).ResultsThe rate of eye exams provided in areas with very high Indigenous populations was two-thirds of the rate of eye exams for areas with very low indigenous populations. The cataract surgery rates in areas with high medium to very high Indigenous populations were less than half that reference areas. In over a third of communities with very high Indigenous populations the cataract surgery rate fell below the World Health Organization (WHO) guidelines compared to a cataract surgery rate of 3% in areas with very low Indigenous populations.ConclusionsThere remain serious disparities in access to eye health service in areas with high Indigenous populations. Addressing disparities requires a co-ordinated approach to improving Indigenous people’s access to eye health services. More extensive take-up of existing Medicare provisions is an important step in this process. Along with improving access to health services, community education concerning the importance of eye health and the effectiveness of treatment might reduce reluctance to seek help.

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

“…However, there is still a shortage of optometric and ophthalmic services in many rural and remote areas (4, 5) and significantly lower rates of eye examinations (by optometrists or ophthalmologists) in areas with higher proportions of Aboriginal and Torres Strait Islander people (4, 6). Current policy recommendations for better Aboriginal and Torres Strait Islander eye care in the “Roadmap to Close the Gap for Vision” place emphasis on primary eye care as part of comprehensive primary health care to address barriers to eye care (7).…”

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

“…The path to care is different for each of the main eye care conditions causing vision loss for Indigenous Australians – cataract, refractive error, diabetes and trachoma – and the availability of practitioners, services and settings supporting eye care are known to vary considerably and geographically across Australia [1-6]. There is attrition of patients along the pathways in Indigenous eye care [6,7] and patients are often not able to successfully negotiate a given care pathway [3,8,9].…”

“…There is attrition of patients along the pathways in Indigenous eye care [6,7] and patients are often not able to successfully negotiate a given care pathway [3,8,9]. Higher risk patients are also known to have a greater chance of not successfully navigating care pathways and suffer a greater consequence for failing to do so [8,9].…”

Reports indicate that changes are needed to close the gap for Indigenous health

“…The 2008 NEIHS found that 35% of Indigenous adults have never had an eye examination [143]. The rate of eye examinations provided in areas with a high Indigenous population was two-thirds the rate of areas with a low Indigenous population [152,154].…”

“…Overall, Indigenous people are less likely than non-Indigenous people to access eye health practitioners, optometry, or specialist ophthalmology services [144,154]. The 2008 NEIHS found that 35% of Indigenous adults have never had an eye examination [143].…”