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

Abstract

BackgroundRoutine 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.MethodsClinical 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.ResultsOverall 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%).ConclusionThere 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.

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

“…The leading causes of vision loss among Aboriginal and Torres Strait Islander Australians nationally are uncorrected refractive error (60.8%), cataract (13.2%) and diabetic retinopathy (5.2%), the latter of which is associated with a high prevalence of diabetes among Aboriginal and Torres Strait Islander people (38% in adults over 55 years) . Issues related to the wide variation in delivery of services, the availability of visiting eye care practitioners in rural and remote areas, integration of eye care into primary care and surgical coverage rates suggest the need for continued improvements to enhance accessibility of eye care services.…”

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

“…Diabetic retinopathy remains asymptomatic until later stages, reinforcing the need for annual screening and early intervention to prevent irreversible vision loss. Despite this, only 33% of Indigenous adults with diabetes undergo eye screening within the recommended time frames 9…”

Visual impairment among Aboriginal and Torres Strait Islander patients attending an Australian Indigenous primary health service: a cross-sectional study

“…Initiatives to reduce the rate of VI for Indigenous peoples have been implemented in Australia with positive outcomes, including a tripling in the number and occasions of services provided to Indigenous people under the Visiting Optometrist Scheme between 2009-10 and 2016-17 (AIHW 2018). Primary healthcare services play an important role in the early identification and treatment of VI, including referral to specialist services (Taylor et al 2012;Abouzeid et al 2015;Burnett et al 2016;Indigenous Eye Health 2017;AIHW 2018). No published study has reported on the prevalence of VI among Indigenous people in the primary healthcare setting.…”

“…No published study has reported on the prevalence of VI among Indigenous people in the primary healthcare setting. A study of 124 Indigenous primary healthcare centres reported wide variations in the percentage of people recorded as having vision assessments according to the recommended guidelines (Burnett et al 2016).…”