Stronger eye care systems in Aboriginal primary health care · 2015-06-16 · Stronger eye care...
Transcript of Stronger eye care systems in Aboriginal primary health care · 2015-06-16 · Stronger eye care...
Stronger eye care systems in Aboriginal primary health care
National Rural Health Conference - 27 May 2015
Anna Morse1,2, Colina Waddell1,2, Jenny Hunt3, Fiona MacFarlane4, Daniel Jackman5, Christine Corby6, Tricia Keys1,2
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
A team effort
Vision CRC Partners
Implementing Partners
Coonamble Aboriginal Health Service
KATHERINE WEST HEALTH BOARD
Presentation Outline
Why focus on Primary Health Care for eye care outcomes?
How was this done?
What happened?
So what does this mean?
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.
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.
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.
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”
WHY Primary Health Care?
►Referral pathways: effective and efficient
WHY Primary Health Care?
►Referral pathways: effective and efficient
WHY Primary Health Care?
►PHC as the foundation for eye care:
broadly acknowledged, but
WHY Primary Health Care?
►PHC as the foundation for eye care:
broadly acknowledged, but
need practical tools to guide it
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”
HOW was it done?
HOW was it done?
►Ongoing, iterative process, asking:
What?
Why?
How?
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
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
Local (clinic) Goal-setting
HOW was it done?
►Systems assessment►Patient experience
►Collaborative approach: range of perspectives
Combined data &
approaches
Gaps &needs
determined
Priorities for
collective action set
Local Organisation
Regional State / National
HOW was it done?
►Guided by focus groups & clinical guidelines►Mix of training activities: 3 x on-site sessions, online module, resources
HOW was it done?
►Highly interactive, linked with CQI process
HOW was it done?
HOW was it done?
www.rahc.com.au/elearning
HOW was it done?
►Supporting systems and processes, including: PHC systems Regional systems Coordination
WHAT happened? CQI Data
► Optometry: improvements for all components access referrals refractive
correction
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%)
WHAT happened? CQI Data
► Increased numbers and completion of specialist eye care pathways: Cataract Diabetes eye care
WHAT happened? Training
WHAT happened? Eye care system
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
SO WHAT does this mean?
►Positive changes after 2 years
►Important these processes are:
translatable simple, practical methods replicable “real life” research
SO WHAT does this mean?
►Foundational role of Primary Health Care eye care improvements evidence to build on other specialty areas
SO WHAT does this mean?
Strategies for the Prevention of Blindness in National Progammes: A Primary Health Care Approach (1997)
“Primary eye care as a part of comprehensive primary health care”
“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”
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.