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Indigenous Eye Health So3ware Supports Andrea Boudville 19 February 2014
Indigenous Eye Health Unit Melbourne School of PopulaFon and Global Health
MSIA Webinar
Indigenous Eye Health Unit • Established in 2008
• Goal – Close the Gap for Vision in Australia
• 2012 Roadmap to Close the Gap for Vision report – 42 recommendaFons to improve access and uFlisaFon of eye care services
The Roadmap to Close the Gap for Vision
April 2013
Vision loss is 11% of the Indigenous health gap.The $70m Roadmap to eliminate vision loss would be only 4% of the $1.6bn allocated in
2009-2013 to Close the Gap.
hNp://iehu.unimelb.edu.au
Background Indigenous Eye Health e-‐Health and Technology Roundtable – June 2013 Recommenda>ons • Develop set of simple clinical prompts for pracFFoners to facilitate
implementaFon of basic eye examinaFons and guidelines for eye care
• Agreement on a suite of eye health indicators to track eye care data and monitor progress on eye health
• Development of prompts to be clinician led and supported by eye care sector and Aboriginal health sector
• Recall and messaging for eye care services (PotenFal to consider how recalls could be linked to PCEHR)
NaFonal Indigenous Eye Health Survey Vision Loss in Children
One fifth as common as in mainstream Vision Loss in Adults
Blindness is 6 times more common Low Vision is nearly 3 times more common
Causes of Blindness in Adults
32% Cataract 14% Refractive Error and Optic Atrophy 9% Trachoma and Diabetic Eye Disease
Overall 94% of Vision Impairment is avoidable
…and 35% have never had an eye exam
We know what we need to do… Diabetes Cataract Trachoma RefracFve Error
ReFnal assessment for those with diabetes (every 12 months) • Ensure provision of laser treatment
If VA is <6/12 or funcFon is impaired refer to eye care pracFFoner for assessment • Ensure provision of surgery
Implement the SAFE Strategy • Surgery, AnFbioFcs, Facial
Cleanliness, Environment
Screening for VA (near and distance vision) refer to optometry
• Ensure provision of spectacles
Medicare and eye examinaFons MBS Health Assessment items for Children, Adults and Older people From 1 May 2013, MBS 715 item includes vision checks and eye exams
Checklist Vision and eye examinaFons in MBS 715
Aboriginal and Torres Strait Islander Health Assessment 1. History
2. Visual Acuity (VA -‐near vision and distance vision)
3. Indigenous adults with diabetes reFnal exam every 12 months
4. Eye examinaFons
Prompts for referral Refer to optometry for…. • reduced vision (VA≤6/12) or eye problems • paFents with diabetes for reFnal examinaFon (or take reFnal photograph with camera and refer for grading)
Refer to ophthalmology for…. • Trichiasis • paFents with diabetes with suspected diabeFc reFnopathy requiring treatment
• PaFents with cataract requiring surgery
NaFonal guide to a preventaFve health assessment for Aboriginal and Torres Strait Islander people
Chapter 6: Eye Health
Key funcFons for primary eye care • IdenFfy and treat common eye condiFons
• IniFate referrals to specialist services
• Support paFents to access treatment and follow up
• CoordinaFon with other services to improve access eye care
Primary Care Roles to Support
Eye Care
1.Iden>fy
2. Eye Assessment
3. Treat Or Refer 4. Review
5.Monitor
How can GP so3ware support these key funcFons?
Supports in GP So3ware Adult health assessments
MBS item 715 billing
Track referral and follow up of paFents with eye care needs
Recall paFents who require follow up
Chronic disease Include eye care templates in chronic disease management plans
Include eye care pracFFoners in Team Care Arrangements (TCAs)
Links to Indigenous Chronic Disease PracFce IncenFve Program (PIP)
Links to coordinaFon and case management i.e. Care CoordinaFon and Supplementary Services (CCSS)
Indicators for repor>ng and monitoring
Facilitate links to naFonal reporFng and monitoring systems for Indigenous health data
Aggregate local eye data and provide input into regional and jurisdicFonal datasets
Track performance on eye health including all eye care referrals
Share informaFon Medicare Local data management
ReporFng eye health data Func>ons within GP soNware to interrogate, extract, collate and report data on eye health Suggested Indictors • Number of people screened for vision/eye problems • Number of people referred with vision/eye problems • Number of people with diabetes (reported as being diabeFc) • Number of people with diabetes referred for reFnal
examinaFon • Number of people with reFnal examinaFon provided/reFnal
photograph taken in clinic • Number of MBS Item 715 (adult and Older Persons) billed
Diabetes Eye Care Pathway
Next Steps • IEHU work with MSIA and members to co-‐design a guide for primary eye care in GP so3ware and reporFng systems
• Provide evidence from the eye care sector and Aboriginal health sector to improve exisFng GP so3ware and compliance with naFonal guidelines
• The prompts and reporFng items for eye health checks in adult health checks and chronic disease management form a potenFal template for other primary health care prioriFes
References The Roadmap to Close the Gap for Vision Report hNp://iehu.unimelb.edu.au/publicaFons/iehu_reports the_roadmap_to_close_the_gap_for_vision
Taylor, H. R., et al. (2012). "The roadmap to close the gap for vision." The Medical Journal Of Australia 197(11): 613-‐615. Boudville, A. I., et al. (2013). "Improving eye care for Indigenous Australians in primary health care sekngs." Australian Journal of Rural Health 21(2): 121-‐127. Indigenous Eye health e-‐health and Technology Roundtable Report – June 2013 hNp://iehu.unimelb.edu.au/ RACGP PreventaFve Health Guide hNp://www.racgp.org.au/yourracgp/faculFes/aboriginal/guides/naFonal-‐guide/
Contacts Andrea Boudville Indigenous Eye Health Unit Melbourne School of PopulaFon and Global Health, The University of Melbourne Level 5, 207 Bouverie St, Carlton, Victoria, 3010 T: +61 3 8344 0753 E: [email protected] W: www.iehu.unimelb.edu.au