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

Key area for action 4: Improving the systems and quality of care

Page last updated: November 2005

Objective:

Eye health care is safe, affordable, well-coordinated, consumer-focussed and consistent with internationally recognised good practice.

Challenges:

Ensuring consistency in the quality of care provided to people with a vision problem is vital. There may be variations between individual eye health practitioners, between metropolitan and rural and remote regions and between mainstream services and those provided to disadvantaged and marginalised communities.

Variations in quality of care due to modifiable factors in eye health care systems can be addressed through quality improvement measures such as systems analysis, clinical frameworks, clinical risk management, incident monitoring, e-health technology, development and implementation of protocols and standards and accreditation of services.

Professional associations play a central role in implementing protocols and strategies to ensure that eye health practitioners are suitably trained, skilled and equipped to identify eye disorders and to undertake the range of procedures required of them. The use of continuing professional development attendance, certification and credentialing, clinical audit and peer review can all assist to address quality of care issues amongst eye care practitioners and reduce the risk of iatrogenic causes of blindness. The development and wide-scale adoption of clinical practice guidelines could also help to ensure that care provided is evidence based and consistent with internationally recognised good practice.

Historically, the eye health care sector itself has been fragmented, with limited communication across disciplines, duplication of effort and resultant public confusion about the roles of the various eye health care practitioners. A culture of collaboration within the eye health care sector would help to reduce duplication and improve service delivery.

The primary health care setting provides an important area in which the quality of eye health care can be improved. General practice is a health care setting where there are frequent presentations by people with eye disease or injury. A key challenge is how best to link workforce development and capacity building in general practice in the better management of eye health with the investments already made in better chronic disease management within general practice. Systematic and integrated shared care programs and up-skilling of general practitioners in the area of eye health are some of the ways primary care could be used to address eye health issues.

The acute care system is another key interface for eye health care. Generalist hospital staff in accident and emergency departments, intensive care units and other areas are frequently required to care for people with eye diseases or injuries, as well as to prevent eye trauma in people who are comatose or heavily sedated. Appropriate training of hospital staff together with supervised practice in basic eye care are therefore important in addressing quality of care issues.

Demographic change, new technologies and increased consumer participation in health care and health care decision making will require new responses to the delivery of eye health care. Major issues include workforce shortages, workforce ageing, uneven distribution of the specialist eye care workforce, the need to keep up-to-date with the current evidence base regarding good practice, new models of care, quality improvement requirements and continued development of the global community.

Flexible boundaries and roles will enable the future eye care workforce to respond to the demand for new types of skills and new disciplines in response to new technologies and work practices. Electronic technologies will revolutionise care delivery, data storage and communication practices. Greater emphasis on health promotion and prevention and the workforce trend towards sectoral specialisation will also have implications for the types of skills required of eye care practitioners.

Finally, self-management programs have been shown to increase the quality of life and self-efficacy of those with chronic disease. There is potential for self-management interventions to be of assistance to people with age-related vision loss.

In summary, a collaborative, multi-disciplinary approach is required to effectively tackle workforce and quality issues in the delivery of eye health care services. The
national investment in eye health can be maximised through better coordination across jurisdictions, service settings, professional groups and the education, training, regulation and industrial sectors.

Actions:

Key area for action 4: Improving the systems and quality of care
Action areaActions
Service integration
  • promote collaboration within the eye health sector itself to improve quality of care and responsiveness to Australian consumers
  • develop models of care which incorporate multi-disciplinary approaches and broaden the workforce base
  • identify structures, systems and arrangements that facilitate the engagement of general practitioners and other primary health care practitioners in eye health
  • integrate eye care into primary health care chronic disease management programs
  • facilitate the effective delivery of community based programs aimed at addressing priority eye health conditions
  • assess and promote effective clinical and referral pathway processes and shared care arrangements to ensure continuity of care across services and practitioners
  • assess viability of increased utilisation of communications technology to provide links from remote communities to central eye specialist services to enhance diagnosis and treatment
  • strengthen partnerships between the mainstream eye health sector and Aboriginal and Torres Strait Islander primary health care services in urban, rural and remote settings
  • develop sustainable models for the provision of outreach ophthalmological and optometrical services to remote settings
  • develop referral pathways that include referrals to vision rehabilitation or low vision services that are available in the community
Workforce development – specialist workforce
  • ensure quality of care provided by eye care practitioners continues to be assured through a range of quality improvement strategies, including mandatory continuing professional development, accreditation of services, clinical audit, peer review, certification and credentialing of practitioners, incident monitoring and benchmarking
  • develop, update, implement and promote evidence based multi-disciplinary guidelines for the prevention, detection and treatment of the most prevalent eye diseases in Australia
  • establish dialogue with the relevant colleges to provide the opportunity for increased Aboriginal and Torres Strait Islander medical officers in the Ophthalmology Training Program
Workforce development – primary health care workforce
  • raise awareness in the primary health care sector of the prevalence and burden of disease associated with the most common eye conditions
  • work with relevant colleges and training institutes to implement and improve professional development programs for primary health care workers in the provision of eye care services
  • enable training of other health professionals to include basic ophthalmology and screening procedures
  • improve the range and level of education and training options in eye health for general practitioners with appropriate credentialing and ongoing monitoring of quality of care
  • explore opportunities to utilise communications technology to provide eye health related training and professional development opportunities to health workers located in remote communities
  • consider strategies such as the development of National Competency Standards for Aboriginal Health Workers, including eye health competencies for each level of training and qualification.
Consumer focus
  • involve people with, or at risk of developing, low vision and blindness in significant service design and delivery decisions, for example through formal consultations and membership of advisory and management committees within the health system
  • trial and evaluate self-management interventions for people with vision loss

National initiatives that impact on improving the systems and quality of eye care

  • Quality and Safety in Care Initiative
  • National Health Workforce Action Plan National Health Workforce Strategic Framework
  • Aboriginal and Torres Strait Islander Health Workforce Strategic Framework
  • Healthy Horizons: A Framework for Improving the Health of Rural, Regional and Remote Australians
Top of page