Stronger eye care systems in Aboriginal primary health care

Transcription

1 Stronger eye care systems in Aboriginal primary health care Anna Morse 1,2, Colina Waddell 1,2, Jenny Hunt 3, Fiona MacFarlane 4, Daniel Jackman 5, Christine Corby 6, Tricia Keys 1,2 1 Brien Holden Vision Institute 2 Vision Cooperative Research Centre 3 Aboriginal Health & Medical Research Council 4 Wurli-Wurlinjang Health Service 5 Coonamble Aboriginal Health Service 6 Walgett Aboriginal Medical Service National Rural Health Conference - 27 May 2015

2 Vision CRC Partners A team effort Implementing Partners Coonamble Aboriginal Health Service KATHERINE WEST HEALTH BOARD

3 Presentation Outline Why focus on Primary Health Care for eye care outcomes? How was this done? What happened? So what does this mean?

4 WHY Primary Health Care? Vision loss for Aboriginal & Torres Strait Islander people is: 1 more common largely avoidable 1. Taylor HR, Keeffe JE, Arnold AL, Dunn RA, Fox SS, Goujon N, et al. National Indigenous Eye Health Survey, Minum Barreng (Tracking Eyes). Melbourne, Australia: Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne, 2009.

5 WHY Primary Health Care? Vision loss for Aboriginal & Torres Strait Islander people is: 1 more common (blindness 6x, low vision 3x) largely avoidable 1. Taylor HR, Keeffe JE, Arnold AL, Dunn RA, Fox SS, Goujon N, et al. National Indigenous Eye Health Survey, Minum Barreng (Tracking Eyes). Melbourne, Australia: Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne, 2009.

6 WHY Primary Health Care? Vision loss for Aboriginal & Torres Strait Islander people is: 1 more common (blindness 6x, low vision 3x) largely avoidable (94%) 1. Taylor HR, Keeffe JE, Arnold AL, Dunn RA, Fox SS, Goujon N, et al. National Indigenous Eye Health Survey, Minum Barreng (Tracking Eyes). Melbourne, Australia: Indigenous Eye Health Unit, Melbourne School of Population Health, The University of Melbourne, 2009.

7 WHY Primary Health Care? Early detection, timely referral, follow-up better outcomes. Diabetes eye care: part of annual cycle, preventative. Primary Health Care (PHC) forms the front line

8 WHY Primary Health Care? Referral pathways: effective and efficient

9 WHY Primary Health Care? Referral pathways: effective and efficient

10 WHY Primary Health Care? PHC as the foundation for eye care: broadly acknowledged, but

11 WHY Primary Health Care? PHC as the foundation for eye care: broadly acknowledged, but need practical tools to guide it

12 HOW was it done? PAR (Participatory Action Research). Aboriginal Community Controlled Health Services (ACCHS): NSW & NT Models of vision care delivery in Aboriginal and Torres Strait Islander communities

13 HOW was it done?

14 HOW was it done? Ongoing, iterative process, asking: What? Why? How?

15 HOW was it done? What? Map services, identify gaps. Regional eye care systems assessment Why? Understand ACCHS priorities - focus groups Review guidelines and evidence base How? Process guided by ACCHS, working together

16 HOW was it done? Framework for the whole process: Building on strengths, Incremental improvement (bit by bit) CQI elements included: File audits & data, CQI cycles Service mapping Action at local, organisational and regional levels Systems assessment, patient experience components

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18 Local (clinic) Goal-setting

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20 HOW was it done? Systems assessment Patient experience Local Organisa tion Regional State / National Collaborative approach: range of perspectives Combined data & approaches Gaps & needs determined Priorities for collective action set

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22 HOW was it done? Guided by focus groups & clinical guidelines Mix of training activities: 3 x on-site sessions, online module, resources

23 HOW was it done? Highly interactive, linked with CQI process

24 HOW was it done?

25 HOW was it done?

26 HOW was it done? Supporting systems and processes, including: PHC systems Regional systems Coordination

27 WHAT happened? CQI Data Optometry: improvements for all components access referrals refractive correction

28 WHAT happened? CQI Data Smaller impact for primary care checks other variables Adult Health Check only Annual diabetes retinal exams: notable increase Consider national average (~25%)

29 WHAT happened? CQI Data Increased numbers and completion of specialist eye care pathways: Cataract Diabetes eye care

30 WHAT happened? Training

31 WHAT happened? Eye care system

32 WHAT happened? Outputs Eye & Vision Care TOOLKIT Integrated, useful and practical set of tools and approaches for supporting eye care systems: CQI tools Education packages Regional planning tools Understanding community

33 SO WHAT does this mean? Positive changes after 2 years Important these processes are: translatable simple, practical methods replicable real life research

34 SO WHAT does this mean? Foundational role of Primary Health Care eye care improvements evidence to build on other specialty areas

35 SO WHAT does this mean? Primary eye care as a part of comprehensive primary health care Strategies for the Prevention of Blindness in National Progammes: A Primary Health Care Approach (1997) primary health care approach to prevention of blindness the provision of eye care as an integral part of primary health care as a key strategy

36 POLICY recommendation Building primary health care capacity is an effective strategy for improving eye care for Aboriginal and Torres Strait Islander people. Therefore, supporting eye care in the Aboriginal and Torres Strait Islander primary health care setting across Australia is important.