Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

Appendix 3.c - Results VOS service provider survey

Page last updated: 28 February 2012

Table 3.28 – Estimate of response rate by state/territory and other summary statistics, VOS provider survey, optometrist level responses

  NSW Vic. Qld WA SA Tas. NT Other Total
Number of survey respondents 9 8 6 1 8 2 6 2 42
Outreach locations for which respondents provided information 15 10 10 4 11 3 11   64
Outreach visits undertake to these locations in 2010-11 180 95 61 6 67 36 26   471
Average visits per location 12.0 9.5 6.1 1.5 6.1 12.0 2.4   7.4
Patient eye examinations conducted in these locations 2,899 1,115 1,991 208 1,662 241 756   8,872
Estimated patient eye examinations for Indigenous patients in these locations 536 94 687 162 395 7 453   2,334
Proportion of patients who are Indigenous % 18 8 35 78 24 3 60   26
Average number of eye examinations per visit 16 12 33 35 25 7 29   19
Estimated proportion of VOS optometrists responding 53% 100% 43% 13% 67% 33% 75%   58%
Estimated proportion of VOS locations in sample 22% 40% 8% 4% 14% 11% 10%   12%
Estimated proportion of VOS supported patients 61% 83% 45% 27% 72% 14% 108%   55%

Table 3.29 – Estimate of locations described in responses by ASGC remoteness area and other summary statistics, VOS provider survey, location specific responses
  Inner Regional Outer regional Remote Very Remote Missing Total
Outreach locations for which respondents provided information 2 19 21 20 1 63
Outreach visits undertake to these locations in 2010-11 17 222 184 40 2 465
Average visits per location 8.5 11.7 8.8 2.0 2.0 7.4
Patient eye examinations conducted in these locations 330 3,157 3,678 1,627 80 8,872
Estimated patient eye examinations for Indigenous patients in these locations 33 431 828 1,040 2 2,334
Proportion of patients who are Indigenous % 10 14 23 64 3 26
Average number of eye examinations per visit 19 14 20 41 40 19
Estimated proportion of VOS locations in sample 7% 16% 18% 7%   12%
Estimated proportion of planned VOS patients seen 10% 20% 42% 15%   23%
Estimated proportion of reported VOS patients seen 19% 40% 112% 49%   55%

Table 3.30 –Location of permanent practice, VOS provider survey, optometrist level responses
  NSW Vic. Qld WA SA Tas. NT Other Total %
1. Capital city 2 4 2 1 4 2 6   21

50%

2. Regional town 8 4 4   4       20 48%
9. No response               1 1  
Total 10 8 6 1 8 2 6 1 42  
Total excluding no response 10 8 6 1 8 2 6 0 41 98%
Percentage 24% 20% 15% 2% 20% 5% 15% 0% 100%  

Table 3.31 –Number of locations visited, VOS provider survey, optometrist level responses
Question Response category Number %
No of discrete towns/communities visited 1. One location 11 29%
2. Two to four locations 12 32%
3. Five to nine locations 10 26%
4. Ten or more locations 5 13%
9. No response 4  
Total 42  
Total excluding no response 38 100%

Table 3.32 – Assessment of effectiveness of program, VOS provider survey, optometrist level responsesTop of page
Question Response category Number %
How effective is VOS in improving access to optometry services for non-Indigenous people living in rural and remote Australia? 1. Very effective 15 41%
2. Reasonably effective 18 49%
3. Not effective 4 11%
9. No response 5  
Total 42  
Total excluding no response 37 100%
 
How effective is VOS in improving access to optometry services for Indigenous people living in rural and remote Australia? 1. Very effective 12 32%
2. Reasonably effective 21 57%
3. Not effective 4 11%
9. No response 5  
Total 42  
Total excluding no response 37 100%

Table 3.33 – Ideas on how VOS supported visits could be more effective, VOS provider survey, optometrist level responses
In what ways could your VOS supported visits be more effective? Responses mentioning these issues
Coordination issues and local support  
Improved coordination in Indigenous health settings, e.g. through Improve funding for eye health co-ordinators, enhancing their role in coordination, reducing rates of no shows, improved coordination with visiting specialist services. 10
Sharing information about schedules for visiting ophthalmologists and also other visiting optometrists 3
Funding and training of support staff in local community settings who can support visiting services. Includes paying for administrative roles and pre-testing. 3
Giving communities adequate notice of visits 1
More flexibility in scheduling visits 1
More support from local GPs 1
Funding issues  
Higher medicare rebate for services in Aboriginal communities 3
Need higher VOS payments for services in Aboriginal communities 1
VOS funding for advertising services 2
VOS funding or support for equipment purchase 1
Administrative issues  
Improved administrative processes related to invoicing and payments, electronic reporting, reduced paperwork, simpler application process. 2
Faster approval of VOS services 1
Expanding VOS  
Increase frequency of visiting supported by VOS 6
Expand VOS services to support more small rural communities 2
Other  
Provide health promotion activities during visits 1
Encourage regional optometrists to provide services 1
Enhance reporting to capture information on outcomes 1
National spectacle subsidy scheme 1

Table 3.34 – Ideas on how VOS supported visits could be more effective, VOS provider survey, optometrist level responses
How could eye health services be better coordinated across VOS and visiting or local ophthalmology services Responses mentioning these issues
Sharing information about schedules for visiting ophthalmologists and optometrists so these are better coordinated. 12
Improved communication between optometrists and ophthalmologists related to patients. e.g. Sharing information about patients who are being actively seen by ophthalmologists 2
Using optometrists to undertake follow examinations for patients of ophthalmologists 1
Specific role to undertake state level coordination of services 2
Regional eye health coordinators with adequate training and resources 3
Better coordination with local primary care teams, including better referral to optometrists 2
Improve community awareness of importance of eye health issues and visiting services 2
Address issues in referral to ophthalmologists: Address financial barriers associated with gap fees for Ophtalmogists who don't bulk bill 2
Outsource administration of scheme to a more knowledgeable group 1
Outsource administration of scheme to MSOAP fundholder 1

Table 3.35 – Satisfaction with VOS, VOS provider survey, optometrist level responsesTop of page
Question Response category Number %
Overall how satisfied are you with VOS? 1. Very satisfied 6 16%
2. Satisfied 21 57%
3. Neither satisfied or dissatisfied 4 11%
4. Dissatisfied 6 16%
9. No response 5  
Total 42  
Total excluding no response 37 100%

Table 3.36 – Reasons for dissatisfaction, VOS provider survey, optometrist level responses
If you are dissatisfied, what are the principal factors that have lead to this assessment? Responses mentioning these issues
Lack of timeliness and delays in decisions about approval of outreach services 2
Delays in receiving payments following submission of invoices 3
Inconsistent service and advice from VOS staff, particularly in negotiating details and reporting/invoicing 1
Payment rates are inadequate. Refusal to approval funding under categories recognised in the guidelines. 1
Guidelines for funding are inappropriate(e.g. excluding services where rooms are permanently leased, where this is the most sensible and cost effective option) 1

Table 3.37 – Intention to continuing providing outreach and age, VOS provider survey, optometrist level responses
Question Response category Number %
How long do you intend to continue providing outreach services under VOS? 1. Less than 12 months 3 8%
2. One to two years 2 5%
3. Three to four years 3 8%
4. Five years or more 28 76%
9. No response 6  
Total 42  
Total excluding no response 36 97%
 
How old are you? 20-29 years 4 11%
30-39 years 6 17%
40-49 years 10 28%
50-59 years 10 28%
60 years and over 6 17%
9. No response 6  
Total 42  
Total excluding no response 36 100%

Table 3.38 – Intention to continuing providing outreach and age, VOS
  20-49 years 50-59 years 60 years and over 9. No response Total
1. Less than 12 months 3 0 0   3
2. One to two years 1 0 1   2
3. Three to four years 2 0 1   3
4. Five years or more 13 10 4 1 28
Total excluding no response 19 10 6 1 36
 
1. Less than 12 months 16%       8%
2. One to two years 5%   17%   6%
3. Three to four years 11%   17%   8%
4. Five years or more 68% 100% 67% 100% 78%
Total excluding no response 100% 100% 100% 100% 100%

Table 3.39 – Intention to continuing providing outreach and age, VOS provider survey, optometrist level responses
What factors would affect your decision to discontinue providing outreach services? Responses mentioning these issues
Age, retirement, health, family, moving states 8
Inadequate funding 12
Location being removed from priority list, losing funding, service being defined as 'branch' 4
Time commitment 1
Finding locum support 2
Too much paperwork, the challenges in dealing with VOS admin 5
Slow payments from VOS causing cashflows problems for business 3
No local community/GP support 3

Table 3.40 – Assessment of administrative processes, VOS provider survey, optometrist level responses
Question Response category Number %
Assessment of the administrative processes for the development and renewal of the VOS contact? 1. Reasonable relative to funding involved 16 46%
2. Onerous relative to funding involved 13 37%
3. I am not directly involved with this admin process 6 17%
9. No response 7  
Total 42  
Total excluding no response 35 100%
 
Assessment of the administrative processes for submitting an invoice and associated reports once services have been delivered? 1. Reasonable relative to funding involved 20 57%
2. Onerous relative to funding involved 10 29%
3. I am not directly involved with this admin process 5 14%
9. No response 7  
Total 42  
Total excluding no response 35 100%

Table 3.41 – Willingness to collect additional data, VOS provider survey, optometrist level responsesTop of page
Question Response category Number %
Would you be willing collect and report on the number of patients with eye conditions other than refractive error (e.g. diabetic retinopathy, glaucoma, cataract) identified as part of your outreach services? 1.1 Yes - Already do so 11 31%
1.2 Yes 23 66%
2. No 1 3%
9. No response 7  
Total 42  
Total excluding no response 35 100%
 
Would you be willing collect and report on the number of patients examined who are referred to an ophthalmologist? 1.1 Yes - Already do so 6 17%
1.2 Yes 28 80%
2. No 1 3%
9. No response 7  
Total 42  
Total excluding no response 35 100%

Table 3.42 – Comments on willingness to collect additional data, VOS provider survey, optometrist level responses
Willingness to collect addition data Response mentioning these issues
Would do so provided additional renumeration is provided for extra paperwork and time required, or additional administrative support 3
Can be time consuming and rubbery. Should be specified as "newly diagnosed", "cataract requiring referral", "required report to primary health provider". 1

Table 3.43 – Suggestions for improving administration of VOS, VOS provider survey, optometrist level responses
What suggestions do you have on how the administration of the VOS program could be improved? Responses mentioning these issues
Planning and developing outreach service proposals  
More transparent process in choosing locations and frequencies 2
Regional Eye health Coordinators should have more influence in VOS 2
More flexibility in circuits 1
Clearer contacts 1
Communication between Department and service provider  
Better communications between the Department and VOS providers. Departmental officers to have a better understanding of optometry services 3
Provide feedback to participating optometrists on overall statistics and provision of services against need, including who is providing services and when they are occurring 2
Administration  
Improved invoicing/payments, including timeliness and information of stage of processing 9
Implement online reporting/submission of invoice 1
Break up payments or have more regular payments closer to when services are delivered rather than on a six monthly basis 2
Reduce paperwork 1
Contract out the administration of VOS 1
Scheme guidelines  
Review guidelines related to definition a service as a 'branch' 1
Provide funding to support local assisting services (i.e. admin, pretesting, screening) 1
More funding to support administration associated with reporting 1
Provide funding for local advertising of the outreach service and standard letter to local health service providers to advise on when visits will occur 1
Data collection  
Collect data on a centralised (deidentified) database 1
Use a standardised reporting template 2
Other  
Use local GPs/AMS/Community health hospital to help manage booking of patients prior to visits 1
Patient and community education on importance of eye health 1

Table 3.44 –Who helps coordinate patients locally, VOS provider survey, location specific responses
Who helps coordinate patients locally? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1.0 REHC 1 2   5 5% 5% 8%
1.1 REHC + AMS 1 3   5 5% 8% 8%
1.2 REHC + AMS + Community health 0 0   2 0% 0% 3%
1.3 REHC + Community health 0 0   1 0% 0% 3%
2.1 AMS 1 2   5 5% 5% 8%
2.2 AMS - Local community health 2 2   2 10% 5% 3%
2.3 AMS - Local hospital 0 0   1 0% 0% 2%
3.1 General Practice 1 4   4 5% 11% 7%
4.1 Local community health 6 10 1 16 30% 26% 27%
4.2 Local community health + Local hospital 1 1   1 5% 3% 2%
4.3 Local hospital 1 4   4 5% 11% 7%
5. NGO 0 1   2 0% 3% 3%
6.2 None 6 9   11 30% 24% 19%
9.0 No response 1 1   2      
Total 21 39 1 61      
Total excluding no response 20 38 1 59 100% 100% 100%
               
Involves REHC 2 5   13 10% 13% 22%
Involves AMS 4 7   15 20% 18% 25%
Involves General Practice 1 4   4 5% 11% 7%
Involves Local community health 9 13 1 22 45% 34% 37%
Involves local hospital 2 5   6 10% 13% 10%
Involves NGO 0 1   2 0% 3% 3%
No assistance with coordination 6 9   11 30% 24% 19%

REHC – Regional eye health coordination; AMS – Aboriginal medical service


Table 3.45 –How well coordinated are VOS outreach services in this location, VOS provider survey, location specific responsesTop of page
If you receive coordination assistance, how well coordinated are the VOS outreach services? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1. Good coordination, problems occur only occasionally 9 16   25 75% 47% 54%
2. Adequate coordination, there are problems but these are to be expected 3 14   17 25% 41% 37%
3. Poor coordination, there are regular problems encountered   4   4 0% 12% 9%
9. No response 9 5 1 15      
Total 21 39 1 61      
Total excluding no response 12 34 0 46 100% 100% 100%

Table 3.46 – What would improve coordination VOS outreach services in this location, VOS provider survey, location specific responses
If coordination is necessary for what would improve the coordination of outreach optometry services in this location? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1. Availability of eye health coordinator 2 5   7 33% 19% 21%
2. More assistance form local service 1 5   6 17% 19% 18%
3. Availability of a driver   1   1 0% 4% 3%
4. Better coordination with Local Aboriginal stakeholders   1   1 0%

4%

3%
5. Community awareness of eye health issues   1   1 0% 4% 3%
6. Share information about visiting other eye health practitioners   1   1 0% 4% 3%
7. Other 2 7   9 33% 26% 27%
8. System is working well 1 6   7 17% 22% 21%
9. Not applicable/No response 15 12 1 28      
Total 21 39 1 61      
Total excluding no response 6 27 0 33 100% 100% 100%

Table 3.47 – Where are patient eye examinations undertaken, VOS provider survey, location specific responses
Where do your examinations take place? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1.0 AMS 5 14   19 25% 36% 32%
2.1 Community Health Service 4 12   16 20% 31% 27%
2.3 Community Health Service - GP practice - General community facility 1     1 0% 0% 2%
2.4 Community Health Service - General community facility   1   1 0%

3%

2%
2.5 Community Health Service - hospital     1 1 0% 0% 2%
3.1 GP practice 1 2   3 5% 5% 5%
3.2 GP practice - General Community facility   1   1 0% 3% 2%
4.1 Hospital 3 2   5 15% 5% 8%
4.2 Hospital - Other   1   1 0% 3% 2%
5.1 General community facility 1 2   3 5% 5% 5%
6.1 Private facility leased by visiting optometrist 5 4   9 25% 10% 15%
9.0 No response 1     1      
Total 21 39 1 61      
Total excluding no response 20 39 1 60 100% 100% 100%

Table 3.48 – Problems in access to state/territory subsidies spectacles, VOS provider survey, location specific responses
Are there problems in eligible patients accessing the state/territory spectacle subsidy scheme? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1. Yes 6 13 1 20 30% 33% 33%
2. No 14 26   40 70% 67% 67%
3. No response 1     1 5% 0% 2%
Total 21 39 1 61      
Total excluding no response 20 39 1 60 100% 100% 100%

Table 3.49 – Problems in access to state/territory subsidies spectacles by state and territory, VOS provider survey, location specific responses
Are there problems in eligible patients accessing the state/territory spectacle subsidy scheme? NSW Vic. Qld WA SA Tas. NT Total
Number of responses                
1. Yes   6 2 2 4   6 20
2. No 14 4 6 2 6 3 5 40
3. No response         1     1
Total 14 10 8 4 11 3 11 61
Total excluding no response 14 10 8 4 10 30 11 60
Percentage by state                
1. Yes 0% 60% 25% 50% 40% 0% 55% 33%
2. No 100% 40% 75% 50% 60% 100% 45% 67%
Total excluding no response 100% 100% 100% 100% 100% 100% 100% 100%

Table 3.50 – Comments on issues in access for state/territory subsidies spectacles, VOS provider survey, location specific responses
State Comments
NSW Almost all Aboriginal patients are eligible to obtain spectacles, contact lenses or low vision aids, through the NSW Governments Spectacles Program (managed by VisionCare NSW).
Vic. There are difficulties in determining if eligible for Victorian or NSW scheme. It is time consuming to have to deal with two different systems
  Paperwork takes several weeks and then the patient need to post paperwork to optometrist or get transport to (regional centre) to complete the glasses delivery. The paperwork requires patient to complete one section but many find it confusing.
Qld Only one (of two) visiting optometrist to the location participates is the state scheme. Patients have to wait till the optometrist who participated to access the state scheme
WA Pension and concession card details not easily accessible.
SA The practice does not handle the state scheme, as it is inadequately funded but has its own rebate scheme modeled on the DVA scheme.
NT

In remote NT communities, there are a decent proportion of eligible Pensioners or Seniors who have not yet been signed up to the NT Pensioner & Career Concession Scheme. Generally though, this is not a carrier as they can be signed up on the spot.

  Outside of Nhulunbuy very few are registered with THS concession scheme although may are eligible. Documentation is difficult even for health centres to organise.
  There is no facility for people to sign up for the Territory Pension concession scheme which means more paper work for me and most clients do not carry identification papers that can be copied to provide proof of age.
  The spectacle subsidy scheme for the NT is not very well managed. The orders are often lost, or returned incorrect. Even when everything goes to plan there is a two month turn around for the order.
  The Fred Hollows low cost spectacle scheme is used instead of the NT scheme.

Table 3.51 – Access for Indigenous patients requiring spectacles, VOS provider survey, location specific responsesTop of page
When an Indigenous patient requires spectacles, what typically happens? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1. The patient will usually be able to obtain spectacles under a state spectacle subsidy 16 24 1 41 84% 62% 69%
2. The local Aboriginal health service will be able to assist with the purchase of   3   3 0% 8% 5%
3. A separate arrangement is in place through which spectacles can be supplied at no charge or low cost to the client 3 12   15 16% 31% 25%
4. No response 2     2      
Total 21 39 1 61      
Total excluding no response 19 39 1 59 100% 100% 100%

Table 3.52 – Referral process to ophthalmologists for Indigenous patients – role of eye health coordinator, VOS provider survey, location specific responses
When an Indigenous patient requires referral to an ophthalmologist and you make a referral to an ophthalmologist, does an Aboriginal Eye Health coordinator assist with the referral (e.g. though making Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1. Yes, in most cases 3 23   26 16% 59% 44%
2. No, this rarely or never occurs 16 16 1 33 84% 41% 56%
3. No response 2     2      
Total 21 39 1 61      
Total excluding no response 19 39 1 59 100% 100% 100%

Table 3.53 – Referral process to ophthalmologists for Indigenous patients, communication to primary health care provider, VOS provider survey, location specific responses
When a patient requires referral to an ophthalmologist for clinical reasons, and you make a referral to an ophthalmologist, will you communicate the results of the consultation back to the patient's Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1. Yes 18 33 1 52 90% 85% 87%
2. No 2 6   8 10% 15% 13%
3. No response 1     1      
Total 21 39 1 61      
Total excluding no response 20 39 1 60 100% 100% 100%

Table 3.54 – Referral process to ophthalmologists for Indigenous patients, assessment of how well the referral pathway works, VOS provider survey, location specific responses
How well does the referral pathway to an ophthalmologist work in this location? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
  n n n n % % %
1. Patients will almost always get to see an ophthalmologist in a reasonable time. 13 18   31 72% 47% 54%
2. In most instances patients will be seen by an ophthalmologist, although this is often 5 17 1 23 28% 45% 40%
3. Many patients will not be seen by an ophthalmologist.   3   3 0% 8% 5%
4. There is insufficient information to be able to assess this. 2 1   3      
5. No response 1     1      
Total 21 39 1 61      
total excluding no response/insufficient information 18 38 1 57 100% 100% 100%
Top of page