Vision 2020 Australia

Transcription

1 Vision 2020 Australia National Eye Health Initiative round two demonstration grants workshop outcomes 23 February 2011 National body working in partnership to prevent avoidable blindness and improve vision care

2 The National Eye Health Initiative In July 2004 the Australian Health Ministers Conference agreed on the need to develop a National Eye Health Plan for Australia to promote eye health and prevent avoidable blindness and vision loss. This initiative was taken in response to World Health Assembly (WHA) resolution WHA56.26, that all member states prepare a national vision plan. Although, as a country, Australia has excellent eye health and vision care services, there is scope for further improvement in the systems and quality of care. The National Framework for Action to Promote Eye Health and Prevent Avoidable Blindness and Vision Loss (National Framework) was developed to provide a structure for governments, health professionals, non-government organisations, industry and individuals to work in partnership. The National Framework was endorsed by Australian Health Ministers in November The Australian Government is committed to improving eye care and eliminating avoidable blindness and visual impairment in Australia and in the Asia Pacific region. In May 2009, the Australian delegation, led by Professor John Horvath, spoke in favour of the Action Plan for the Prevention of Avoidable Blindness and Visual Impairment (Action Plan), which was endorsed by the WHA. The endorsement of the WHA Action Plan is a mandate for the Australian Government to invest further in eye health nationally. In accordance with the WHA resolution, the focus of the National Framework is on the proactive elimination of avoidable blindness and vision loss in Australia. Avoidable blindness and vision loss refers to vision impairment due to conditions that are potentially preventable through the modification of known risk factors, or for which effective treatments exist to restore sight or prevent further vision loss. The key action areas of the National Framework are: reducing the risk of eye disease and injury increasing early detection improving access to eye health care services improving the systems and quality of care improving the underlying evidence base. Information about the National Framework can be found at: internet/main/publishing.nsf/content/ageing-eyehealth-framework-toc.htm 2 National Eye Health Initiative Workshop February 2011

3 In the Budget the Australian Government provided funding of $13.8 million over four years for a National Eye Health Initiative (NEHI) to promote eye health and to strengthen eye health care service delivery. The NEHI funds a range of activities including: eye health promotion activities to encourage Australians to look after their eyes the eye health demonstration grants program health care workforce initiatives to improve the quality of eye health care, including the development of multi-disciplinary clinical practice guidelines for major eye conditions and the education and training of relevant health and other professionals in the prevention, early detection and treatment of eye disease the trialling and evaluation of different eye care delivery models, particularly to disadvantaged and marginalised groups and rural and remote communities formative, attitudinal, evaluation and health services research to underpin the above activities. Activities funded under the eye health demonstration grants program are intended to support the implementation of the National Framework. Demonstration grant funding was released in two rounds with a focus on demonstration projects to trial and evaluate new approaches to the delivery of eye health care which support the implementation of the National Framework. In particular this program aims to identify, trial and evaluate strategies that: overcome inefficiencies in the delivery of eye health care improve access to eye health care, particularly for marginalised and disadvantaged groups, including people in rural and remote communities and Aboriginal and Torres Strait Islanders improve the quality and safety of eye health care. Funding was provided to projects that have the potential to enhance the delivery of eye health care and improve the quality and safety of care. Priority was given to proposals that targeted marginalised and disadvantaged people or groups at particular risk of eye disease and injury. The first round of demonstration grants were completed in 2009 and a workshop was held on 11 and 12 November 2009 in Melbourne. A copy of the outcomes document from that workshop National Eye Health Initiative round one demonstration grants workshop outcomes November 2009 is available on the Vision 2020 Australia website or by calling The views expressed in this document are those of the author(s) and do not necessarily reflect the views of the Australian Government. 3

4 NEHI round one demonstration grants $197,500 to Association for the Blind of Western Australia for a trial and evaluation of innovative methods of eye health education. $191,800 to CanDo4Kids Townsend House, South Australia, to conduct a pilot of a new eye health and low vision initiative for children and their families through the Children s Centres for Early Childhood Development and Parenting across the state. $159,970 to Canning Division of General Practice, Western Australia, to engage an Aboriginal Eye Health Worker to improve the coordination of eye health and vision care for Aboriginal and Torres Strait Islander clients in mainstream general practice. $199,810 to Curtin University of Technology, Western Australia, for a trial and evaluation of self-management approaches to managing eye disease and injury. $75,300 to Glaucoma Australia to undertake a glaucoma outreach project in Northern Queensland and the Northern Territory. $200,000 to Guide Dogs Association of South Australia and Northern Territory to undertake a pilot to improve the coordination of eye health and vision care services for older people in communities across South Australia. $198,896 to International Centre for Eyecare Education, New South Wales, for a training program to develop the skills and knowledge of Aboriginal eye health workers in the Northern Territory. $198,550 to Murdoch Children s Research Institute, Victoria, for a pilot project to determine the effectiveness of childhood vision screening for Australia. $199,656 to National Ageing Research Institute, Victoria, to identify the magnitude of vision impairment and its interaction with environmental problems for older people in residential care in metropolitan and regional Victoria. $29,925 to Queensland Vision Initiative to undertake an eye health and vision care referral pathways project in metropolitan Brisbane. $92,800 to Royal Guide Dogs Association of Tasmania for a pilot project to improve the coordination of eye health and vision care across Tasmania. $200,000 to Royal Victorian Eye and Ear Hospital to trial and evaluate shared care arrangements in managing glaucoma, diabetic eye disease and age-related macular degeneration. $197,800 to University of Western Australia to pilot an integrated telemedicine project to provide specialist eye care services. 4 National Eye Health Initiative Workshop February 2011

5 NEHI round two demonstration grants $150,000 to The Fred Hollows Foundation* to improve the co-ordination and quality of eye health and vision cares services for the Top End. $150,000 to International Centre for Eyecare Education, New South Wales*, to improve awareness and accessibility to quality eye health and vision care education resources for Indigenous communities in remote areas of Australia. $53,950 to Limestone Division of General Practice, South Australia*, to provide a series of workshops for general practitioners, practice nurses and Aboriginal Health Workers to enhance their eye care skills and to improve triage of eye incidents and referral protocols. $69,990 to Macular Degeneration Foundation* to pilot an education program for general practitioners focusing on developing skills in early detection and management of macular degeneration. $94,200 to Optometrists Association Australia (NSW Division)* to pilot a collaborative eye health and vision care initiative for the Australian Capital Territory. $150,000 to Queensland Aboriginal and Islander Health Council to undertake a review of eye health services within Aboriginal and Islander Community Controlled Health Services in Queensland and implement accredited eye care training for eye care providers. $71,150 to Queensland Vision Initiative* to undertake an eye health and vision care referral pathways project in regional, rural and remote areas of Queensland. $150,000 to Riverina Division of General Practice, New South Wales, to pilot, implement and evaluate an innovative practice-led, pre-school aged, opportunistic vision screening program through academic professional development training. $130,128 to Royal Hobart Hospital, Tasmania*, to trial a method to reduce glaucoma blindness by improving early detection of undiagnosed glaucoma in high risk individuals. $146,382 to Royal Society for the Blind of South Australia* to pilot a co-ordinated system of eye care and low vision services for people experiencing vision loss as a result of an acquired brain injury. $148,984 to University of Western Australia* to pilot the establishment of a cataract surgery registry in Western Australia to monitor outcomes and adverse events. $95,982 to Western Australian Country Health Service Goldfields to pilot the establishment of a regional retinal screening program in partnership with the local Aboriginal Community Controlled Health Organisation and eye health care providers. *Attended workshop 5

6 The NEHI round two demonstration grants workshop The Australian Government Department of Health and Ageing (DoHA), in collaboration with Vision 2020 Australia, held a workshop in Sydney on 23 February 2011 for grant recipients to meet and share information about projects funded under the round two demonstration grants program and to consider their national applicability. Carol Lankuts, Director of the Healthy Ageing, Cultural Diversity and Eye Health Section, Office for an Ageing Australia, DoHA opened the proceedings and outlined the importance of the demonstration grants program. She indicated the ongoing commitment of the Government to improving eye health by announcing a stocktake of current activity against the National Framework. The review will inform the progress report against the National Framework to the Australian Health Ministers Conference in 2011 as well as Australia s progress report to the World Health Assembly in Importantly it will provide critical input into revising the National Framework. Jennifer Gersbeck, Chief Executive Officer of Vision 2020 Australia provided an overview of the work of the organisation and its role as peak body. She explained Vision 2020 Australia s involvement in the development of the National Framework and how the organisation assisted its members in their application for round one and round two grants funding. Jennifer commented on the importance of building on those grants which were nationally applicable and could lead to sustainable eye health and vision care interventions. She commended the Australian Government for funding the national stocktake of current activity against the National Framework and how this, combined with the findings of the demonstration grants program, will provide a strategic platform from which to move forward. Representatives from nine of the twelve demonstration grants delivered a presentation which covered key objectives, outcomes and learnings from their initiative. Workshop participants then discussed the benefits and opportunities of each project, looked for synergies between projects, broader programs and interventions and discussed ways to overcome any project barriers. The nine presentations were split across four project themes: awareness raising projects professional development projects Aboriginal and Torres Strait Islander projects other eye health projects. During the workshop participants were presented with a range of new ideas and approaches and were involved in considering how the experience gained through a project could be leveraged to have a more significant impact on eye health and vision care outcomes. A snapshot of each project and common issues that were shared across a number of the initiatives in both round one and round two demonstration projects are provided. 6 National Eye Health Initiative Workshop February 2011

7 Common themes Many themes emerged during this workshop which had also been identified in the round one workshop. Professional awareness the projects recognised the importance of a broad range of health professionals having the necessary information about all aspects of eye health and vision care. Round one projects identified the need to engage health professionals and provide information on referral pathways, who s who in the eye heath and vision care sector and services provided by low vision providers. Round two projects also identified the importance of raising awareness of eye health and low vision services with allied health workers such as psychologists, occupational therapists and pharmacists. Cross sectoral approaches just as the round one workshop had identified the need for the eye health and vision care sector to work with a range of other sectors to achieve systemic change, the round two workshop reiterated the importance of working closely with the aged care sector. Technology was highlighted in both workshops as critical to the delivery of information. It was recognised as important for keeping the sector and the community up to date and aware of all aspects of eye health care and vision care. The round two workshop recognised the importance of e-health initiatives and the opportunities created by telemedicine and e-health by the eye health and vision care sector for positive health outcomes. General Practitioner (GP) engagement remained a priority issue for participants in both workshops. Both identified GPs as time poor which made it difficult to engage with them. Round two projects explored some new ways of engaging that recognised and worked around the lack of time while acknowledging it is still an impediment to effective interventions at the GP level. Common language was raised as an issue in both round one and round two workshops. The common use of terms such as screening or assessment is critical to building shared understanding. Working together both rounds of demonstration grants identified the benefits of embedding eye health initiatives within existing interventions or processes rather than creating new or single issue interventions. The round two projects identified an opportunity to embed low vision interventions into the Aged Care Assessment Team (ACAT) assessment. Partnerships and relationships as in round one, round two projects highlighted the importance of developing effective partnerships where there was genuine engagement and real interest in the outcomes from all partners. Both rounds recognised that it takes time to build relationships and that project and intervention outcomes depend on the quality of those relationships. Community awareness is critical to the success of many initiatives. The need for greater community awareness was raised at both workshops. This highlighted an opportunity for overarching eye health and vision care social marketing interventions. Training and accreditation projects in both rounds highlighted the need to integrate eye health care and low vision education within the training of medical students and in the ongoing education of medical practitioners through accredited courses that provide Continuing Professional Development (CPD) points. Champions the importance of champions and the positive role they play was a common theme across both grants rounds. Duplication round two projects highlighted the importance of avoiding duplication by states and territories where there are opportunities to develop and share information and resources nationally. 7

8 The following project snapshots are short descriptions of what are often complex and multifaceted projects. They do not purport to summarise every aspect of a project but highlight some of the findings and positive outcomes. Key workshop reflections are drawn from participant discussion held at the end of each presentation session. Common questions were used to guide discussion, including: What do you see as the key benefits and opportunities from this project? Do you think that the project is relevant in other states and territories? Does this project display synergy with other eye heath interventions and could it be integrated as part of a broader program? Could the barriers faced be overcome on a national level and how could this be achieved? The presentations were informative and provided a good scope of the different projects that were undertaken. 8 National Eye Health Initiative Workshop February 2011

9 Awareness raising projects Regional Referral Pathways Project Queensland Vision Initiative Presented by Greg Johnson and Jane Fleming The Queensland Vision Initiative project aimed to improve the coordination, quality and delivery of eye health care and vision care services in regional, rural and remote Queensland. The project included the completion of a literature review to scope current referral practices, the provision of eye health and vision care information at health professional continuing education events, information distributed through the Vision Initiative e-newsletter, other newsletters, expos, conferences, seminars and trade shows. It involved the development and production of an information resource available through the internet for eye health care practitioners and low vision service agencies in regional, rural and remote Queensland. Positive outcomes from the project included: the positive impact of the website, newsletters and continuing education program in increasing eye health and allied health professionals knowledge of services provided by low vision agencies and community groups the identification of the current referral practices between health professionals, low vision agencies and community organisations highlighted issues and led to recommendations for improved eye health services in Queensland improved communication, coordination and collaboration between Queensland s eye and allied health professionals. A key workshop reflection: The one-stop-shop of information is a very positive development and is something that could be done nationally to avoid duplication and maximise available resources. ACT Eye Health and Vision Care Initiative Optometrists Association Australia (OAA) Presented by Margaret Noonan and Graeme Wolfenden The OAA project aimed to use a capacity building approach to ensure coordination between organisations involved in eye heath and vision care and to improve the knowledge and awareness of eye health and vision care issues. Project activities included education sessions to key health groups, introducing eye questions into the ACAT assessment tool, eye education needs assessment across a range of health providers, the production of information resources and delivery of eye health and vision care presentations to key stakeholders and the integration of eye health and vision care information into a range of existing events and programs. Positive outcomes from the project included: an increased number of registrations for professional development on eye health and vision care among the nursing profession and increased awareness of eye health among GPs, pharmacists and the ACAT positive public support for promotion activities designed to increase eye health awareness to the general public and an increased profile of eye health within the ACT Government an encouraging response to the expression of interest for the inclusion of eye care within the ACT Diabetes Service. A key workshop reflection: The use of the internet increased the engagement of all sectors and is both cost effective and sustainable. The inclusion of eye health questions into the ACAT assessment tool has national applicability and is sustainable. 9

10 Professional development projects Eye Health Workshops Limestone Division of General Practice Presented by Nadine Long and Robyn Wyld The Limestone Division of General Practice aimed to enhance the eye skills of GPs, encourage efficient access to superior eye care by regional residents, enhance the eye skills of practice nurses and Aboriginal Health Workers and to ensure they included eye health information and monitoring in their awareness raising of health issues with Indigenous people. Project activities included a series of three hour workshops conducted with rural GPs at three locations within the Division. Positive outcomes from the project included: a number of GPs were taught to undertake a range of ophthalmic assessments and procedures GPs, Aboriginal Health Workers and practice nurses can now undertake eye health checks and refer patients accordingly GPs and the engaged ophthalmologist have agreed on common language assessment strategies and referral processes. A key workshop reflection: Part of the success of this project is that GPs were identified as the critical local point of call for those with eye health and vision care issues and the GPs were receptive to the training as they had themselves nominated eye health and vision care as a priority for enhanced skills. 10 National Eye Health Initiative Workshop February 2011

11 The Eye Healthcare Partnership Project Macular Degeneration Foundation (MDF) Presented by Julie Heraghty The Eye Healthcare Partnership Project was designed to improve the knowledge and skills of GPs in prevention, early detection and management of Macular Degeneration (MD) through the delivery of a comprehensive accredited CPD program for GPs. Project activities included building a relationship with the six divisions of the Royal Australian College of General Practitioners with the largest over 50 years of age population, developing an education program with the highest level of CPD points, building the session on information from the GPs about their awareness of MD, delivering three hour sessions to GPs and the promotion of MDF through flyers, radio, media articles and presentations. Positive outcomes from the project included: 168 GPs across six divisions attended the workshop and generally found it met their needs and was relevant to their practice there was significantly increased knowledge of all aspects of MD and Charles Bonnet Syndrome every GP received a GP designed Amsler Grid GP information kits and flyers were well received. A key workshop reflection: The success of this project involved the capacity to engage GPs effectively. The inclusion of other eye diseases in addition to MD and the recognition of the personal and psychological aspects of low vision were important to its success. It has synergies with other professional education programs for GPs and allied health workers and could be integrated into a broader training program. 11

12 Other eye health projects Vision Loss as a Result of Stroke and Other Brain Injuries Royal Society for the Blind of South Australia Presented by Margaret Brown The Royal Society for the Blind of South Australia set out to improve the understanding, identification and rehabilitation of individuals with neurological vision loss. Project activities included a trial to evaluate the effectiveness of Neuro Vision Technology s (NVT) therapy with people who experience hemianopia following a stroke, the development of an education package for people with an acquired brain injury, their family s carers and health professionals and the development of a standardised screening model to identify vision loss as a result of acquired brain injury. Positive outcomes from the project included: NVT scanning was effective in demonstrating improving orientation and mobility resulting in improved service delivery the development of the Neurological Vision Loss booklet and a website that has had significant hits and downloads increased knowledge and skills within the Royal Society for the Blind of South Australia on both vision loss and research requirements. A key workshop reflection: The resources developed in this project are applicable across Australia. The NVT has potential application across other eye health conditions such as retinal dystrophies affecting central vision. Establishing a Cataract Surgery Outcomes Register University of Western Australia Presented by Trish Barrett and Jonathon Ng The University of Western Australia s project was to pilot the establishment of a cataract surgery registry in that state to monitor outcomes from surgery, adverse events and to determine its usefulness in assessing surgery outcomes. Project activities included the development of ecat, an electronic cataract auditing tool; its installation and promotion across selected Western Australian hospitals, staff training of the system and the development of user manuals. Positive outcomes from the project included: the system was installed in all WA teaching hospitals staff were trained and manuals developed templates developed for data entry as well as customised operation reports a wide cross section of surgeons were involved in beta testing. A key workshop reflection: This innovative program encourages best practice based on relevant information underpinned by ophthalmologists. It is a project that has national and international relevance for broader ocular and non-ocular surgery. 12 National Eye Health Initiative Workshop February 2011

13 Improving Early Detection of Undiagnosed Glaucoma in High Risk Individuals The Royal Hobart Hospital Presented by Sandra Staffieri and Lisa Kearns The Royal Hobart Hospital trialled improving early detection of undiagnosed glaucoma in high risk individuals to reduce glaucoma blindness through screening them by using a telemedicine approach. Project activities included identifying individuals with primary open angle glaucoma and asking them to nominate First Degree Relatives (FDR) to be approached for screening, training a registered nurse to undertake all the necessary clinical examinations to collect the data, examining participation rates and barriers to participation, developing systems and processes for the efficient collection and dissemination of clinical data and producing education materials in conjunction with Glaucoma Australia. Positive outcomes from the project included: diagnosing one case of glaucoma in every nineteen FDRs screened evidence that targeted screening is 3.5 times more effective than general population screening a very positive response from most FDRs contacted a telemedicine model with effective systems and processes for screening high risk individuals was developed. A key workshop reflection: This was a high impact project with immediate and tangible results that would have economic as well as health impacts. It has synergy with other screening programs and there would be benefits to rolling it out nationally. 13

14 Aboriginal and Torres Strait Islander projects Improving the coordination of eye health and vision care services in the Top End of the Northern Territory The Fred Hollows Foundation Presented by Kate Sieh and Angus Thornton The Fred Hollows Foundation project was focused on improving the coordination and quality of eye health and vision care services for the Top End of the Northern Territory. This was an exceptionally complex project which aimed to develop partnerships, identify service gaps and develop and evaluate an integrated and coordinated eye health and vision care model. Project activities included holding meetings and workshops, developing the principles behind a model for eye health and vision care services, evaluating this project in the Top End against outcomes from a similar project in Central Australia and Barkly so that lessons could be learnt for future projects. Project outcomes included: recognition that programs such as this need a champion from among the service providers understanding that projects benefit from clear statements of vision and an articulation of what success would look like appreciation that projects such as this take years to achieve change and that partnerships need a shared purpose and commitment recognition that government and senior representatives from primary and tertiary services need to be heavily involved in projects of this nature. A key workshop reflection: This project highlighted the importance of embedding strong governance arrangements and engaging government and service representatives. 14 National Eye Health Initiative Workshop February 2011

15 I See for Culture International Centre for Eyecare Education Presented by Tricia Keys The International Centre for Eyecare Education project was designed to improve access to quality image based eye health and vision care education resources which were useful, effective and culturally appropriate for remote Indigenous communities. Project activities included scoping and reviewing existing resources, consulting stakeholders about the ideal package, developing new, complementary resources and promoting and disseminating the resource package to 150 remote and rural health centres and awareness raising activities for health workers. Positive outcomes from the project included: the development of the I See for Culture resource kit with flipcharts, posters and a kit including these and a model eye, imitation spectacles and an instruction manual distribution of kits to 150 Indigenous health centres and online public access to downloadable PDF flip chart and posters increased awareness of the kits positive endorsement and support for the kits survey results which indicated a high level of usefulness and effectiveness. A key workshop reflection: This project followed a good process of consultation through to evaluation and feedback and the final product was well received. 15

16 Another great workshop highlighting some really interesting projects and lessons learnt. The workshop received universal positive feedback from the attendees who all felt they benefited from the opportunity to share the experiences of their projects. Vision 2020 Australia will provide a report to DoHA further detailing workshop outcomes. This report will be available for use in the evaluation of the NEHI demonstration grants program. Thank you to everyone who gave their time to share the results of their demonstration grants projects and to listen to and discuss the presentations of other participants. For more information please contact: Vision 2020 Australia Level 2, 174 Queen Street Melbourne VIC 3000 (03) info@vision2020australia.org.au The National Eye Health Initiative round two demonstration grants workshop was supported by the Australian Government