National framework for action to promote eye health and prevent avoidable blindness and vision loss

Key area for action 3: Improving access to eye health care services

Page last updated: November 2005

Objective:

All Australians have equitable access to appropriate eye health care when required.

Challenges:

Since effective sight preserving interventions exist for many eye conditions, it is essential that Australians can access eye health care services when the need arises. Where eye disease cannot be prevented or treated, the quality of life for people with low vision can be greatly improved with rehabilitation and support. Many services and devices are available to help people maintain their independence. All Australians should have equitable access to high quality eye health care services, irrespective of geographical location, socio-economic status, ethnicity, age or gender.

Access to ophthalmology services may be required across a range of medical specialities, since eye diseases may be complications of diseases such as diabetes, thyroid disease, neurological and neurosurgical conditions and HIV/AIDS.

Factors influencing access to eye health care include:
  • workforce supply
  • he availability of services, particularly in rural and remote areas, including regularity of services and appropriate technological support
  • affordability of services
  • cultural appropriateness of services
  • physical accessibility
  • public awareness of available services.
The adequacy of the existing eye health care workforce, demand for services and projected workforce requirements need to be monitored to ensure that the availability of trained eye care practitioners is commensurate with need. Eye care practitioners include ophthalmologists, orthoptists, ophthalmic nurses and optometrists.

With the ageing of the Australian population and population increases, as well as the ageing of the ophthalmologist workforce, there may over time be a need for an increase in funded ophthalmology training positions and trainees. Strategies to address localised shortfalls in supply include providing incentives for remote area work and up-skilling of general practitioners. There is an opportunity to consider alternative and expanded professional roles.

There is potential to significantly improve access to services through the development of new service delivery models supported, where appropriate, by changes to the roles of health practitioners involved in the delivery of eye care. For example, consideration could be given to upskilling nurses and Aboriginal health workers in some areas of preventive and primary eye care, or increasing outreach services when a permanent workforce cannot be maintained. Relevant other professions include orthoptists, optometrists and optical dispensers.

Provision of specialist ophthalmology and optometry services outside capital cities and major urban areas continues to be a major issue in Australia, especially in regard to the effectiveness of incentives for specialists to practise in rural areas. The Medical Specialists Outreach Assistance Program and the Support Scheme for Rural Specialists are examples of two national programs that aim to support the provision of specialist care to people in rural and remote areas. The Visiting Optometrists Scheme (VOS) commenced in mid 1970s to provide access to optometrical services in rural and remote Australia and is administered by the Department of Health and Ageing.

Lack of appropriate training and retraining opportunities together with inappropriate remuneration and indemnity arrangements appear to be some of the barriers to rural and remote general practitioners’ obtaining and using ophthalmology skills.

Many rural and remote areas are being serviced by outreach services, with city-based specialists visiting to provide consultation and procedural treatment. Many of these outreach arrangements have developed historically. There is a need for better coordination between programs targeted at populations in isolated areas, for example, coordination between outreach schemes funded under the Regional Health Strategy and Aboriginal and Torres Strait Islander primary health care services. Outreach eye care services integrated into community settings may enhance access by low income and Aboriginal and Torres Strait Islander people. Additional challenges are associated with facilitating access to services by urban Aboriginal and Torres Strait Islander people.

Disparities in services also occur within metropolitan areas, with service development at times lagging behind population growth in newer growth areas. With population growth the distribution of ophthalmic services within metropolitan areas will also require review, to ensure equitable access to local ophthalmology services in metropolitan areas. Outer metropolitan areas and newer services often face similar challenges to rural areas in attracting specialist staff to develop and expand services.

In Australia cataract surgery is one of the most common surgical procedures with well established effectiveness at preventing blindness and low vision. Cataract surgery is a highly cost-effective procedure which leads to improved levels of visual acuity and/or functioning in 80% to 95% of patients. Surgery on a second affected eye results in significant benefit which may be nearly as great as from surgery on the first eye.

It is anticipated that there will be increasing demand for cataract surgery due to the ageing population, the increase in population and the lowering of the threshold for cataract surgery.

The development and implementation of further waiting list management strategies may be of benefit in some states to ensure that Australians do not experience unnecessary delays in the restoration of vision. Waiting list management strategies could include the development and implementation of guidelines for reasonable waiting times as well as standards for prioritisation of cases.

Cultural appropriateness is also important to ensure that eye health services are accessible to people from culturally and linguistically diverse backgrounds. Cultural factors must be determined and included in the planning and implementation phases of services with eye health practitioners acquiring the relevant skills needed to provide services that are sensitive to the specific cultural needs of the client.

Barriers to accessing low vision services are often due to the fact that low vision and vision management services are treated as an add on, rather than part of the continuum of eye care programs. Barriers to accessing available low vision services may also be emotional, such as shock, fear, denial and embarrassment. There is a reported low uptake rate for assisted technology. Many people do not know what is available or what their options are regarding appropriate eye care and therefore may be needlessly dependent on others for care.

Appropriate physical location of eye care services is an important consideration for people with low vision. The provision of appropriately darkened rooms and other facilities in aged care services would assist visiting optometrists and other eye health workers. Clear signage and other design features of premises can help to maximise accessibility to consumers.

Access to eye care services may also be affected by a lack of awareness on the part of the public regarding availability of different types of eye health care services and confusion about the specific roles of various eye health practitioners. Awareness raising strategies regarding available services and what to expect may be of benefit in this regard, as may research into the barriers to accessing available services.

Actions:

Key area for action 3: Improving access to eye health care services
Action areaActions
Workforce supply
  • monitor requirements and supply projections for eye care practitioners
  • explore innovative approaches to addressing distribution issues, including incentives for ophthalmologists, orthoptists, ophthalmic nurses and optometrists to practise in areas of greatest need and shortage
  • review the number of funded ophthalmology training positions and trainees as required to match the potential future growth in activity due to population growth and population ageing
  • upskill general practitioners to undertake basic ophthalmic examinations and procedures, particularly in rural and remote areas
  • develop and trial new eye care service delivery models, including the upskilling of nurses and Indigenous Health Workers in selected areas of preventive and primary care
  • develop and trial expanded roles of current eye care practitioners and new workforce roles
Rural and remote communities
  • improve the capacity of the eye health care sector to utilise existing Federal and State mechanisms such as those under the Rural Health Strategy
  • explore incentives for eye care practitioners to participate in outreach services in rural and remote areas
  • examine existing programs, such as the Visiting Optometrists Scheme, to ensure that they are appropriately targeted and promoted
  • explore mechanisms by which low vision and rehabilitation services can be provided to remote and regional areas.
Access to cataract surgery
  • review models of care for cataract management to identify good practice
  • implement waiting list management strategies to reduce waiting times for cataract surgery
  • monitor access to public hospital elective surgery to inform hospital eye health performance information and eye surgery service planning
Affordability
  • identify effective models of state based programs which provide access to eye health care to disadvantaged and marginalised groups
  • ensure public awareness that optometrist eye examinations are covered by Medicare
  • ensure that subsidised spectacles programs are accessible to disadvantaged groups, particularly Aboriginal and Torres Strait Islander peoples who reside in remote locations
  • review funding and incentive programs for eye care specialists providing visiting and support services to rural and remote locations
Cultural accessibility
  • facilitate the use of Aboriginal Liaison Officers in mainstream health services, particularly hospitals providing public ophthalmology services, to reduce barriers and maximise access
  • support cultural awareness training and education programs to ensure the delivery of services that are sensitive to cultural specific needs delivered in a mainstream setting
  • build the capacity of eye health practitioners to deliver services in partnership with Aboriginal and Torres Strait Islander primary health care services
  • support research into the barriers to accessing eye care services by disadvantaged and marginalised groups
Public awareness
  • raise awareness of the types of eye health care services available and the specific roles of different eye care practitioners
  • raise awareness of low vision management strategies and the availability of special interest, self-help and support groups
  • improve public awareness of the range of low vision services, rehabilitation, support, counselling and devices available
  • ensure awareness raising activities cover children, disadvantaged families and high risk youth populations
Research
  • support further health services research to identify barriers to access and strategies to improve access to eye health care
  • explore the potential of new technologies such as telemedicine to improve access to specialist eye care in rural and remote Australia.

National initiatives that impact on improving access to eye health care services

  • National Health Workforce Strategic Framework
  • National Health Workforce Action Plan
  • Healthy Horizons: A Framework for Improving the Health of Rural, Regional and Remote Australians
  • Rural Chronic Disease Initiative
  • Aboriginal and Torres Strait Islander Health Workforce Strategic Framework
  • National Aboriginal and Torres Strait Islander Eye Health Program
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