Using quality improvement strategies to strengthen regional systems for Aboriginal and Torres Strait Islander eye health in the Northern Territory

• Published in: The Australian journal of rural health 2020-02, Vol.28 (1), p.60-66
• Main Authors: Yashadhana, Aryati, Morse, Anna, Tatipata, Shaun, Lim, Nicole, Rogers, Alison, Lee, Ling, Burnett, Anthea M.
• Format: Article
• Language: English
• Subjects: Aboriginal and Torres Strait Islander Health; Adult; Aged; Aged, 80 and over; Audits; Australasian cultural groups; Clinical audits; Clinical outcomes; Colonies & territories; Community; Community Health Services - organization & administration; Community Health Services - statistics & numerical data; continuous quality improvement; Data quality; Diabetes; Diabetes mellitus; Eye examinations; eye health; Eyewear; Female; Health care; Health Promotion - methods; Health services; Health Services, Indigenous - organization & administration; Health Services, Indigenous - statistics & numerical data; Health status; health systems; Humans; Indigenous peoples; Interest groups; Male; Medical referrals; Middle Aged; Native peoples; Needs assessment; Northern Territory; Ophthalmology; Optometry; Optometry - education; participatory action research; Patients; Polls & surveys; Prescription drugs; Primary care; Quality control; Quality improvement; Quality Improvement - organization & administration; Quality Improvement - statistics & numerical data; Quality management; Quality of care; Referrals; Regional analysis; Regional development; Regions; Socioeconomic factors; Spectacles; Stakeholders; Surveys and Questionnaires; Systems approach; Total quality
• ISSN: 1038-5282; 1440-1584; 1440-1584
• DOI: 10.1111/ajr.12575

Problem In the Katherine region, Northern Territory, barriers to eye care for Aboriginal and Torres Strait Islander people include unclear eye care referral processes, challenges coordinating patient eye care between various providers, complex socioeconomic determinants and a lengthy outpatient ophthalmology waiting list. Design Mixed methods participatory approach using a regional needs analysis, clinical file audit and stakeholder survey, to develop, implement and monitor quality improvement strategies. Setting Collaboration with Aboriginal Community Controlled Health Services and regional eye care stakeholders in the Katherine region. Key measures for improvement Clinical audit data captured frequency and rates of primary eye checks, ophthalmology referrals and spectacle prescriptions. A survey was developed and applied to assess stakeholder perspectives of regional eye care systems. Strategy for change Quality improvement strategies informed by regional data (clinical audits and survey) included increasing service delivery to match eye care needs, primary eye care training for Aboriginal Community Controlled Health Services staff, updating Aboriginal Community Controlled Health Services primary care templates and forming a regional eye care coalition group. Effects of change Post‐implementation, rates and frequency of recorded optometry examinations, number of spectacles prescribed and rates of annual dilated fundus examinations for patients with diabetes increased. There was a decrease in the number of patients with diabetes who had never had an eye examination. Eye care stakeholders perceived a marked improvement in the effectiveness of the regional eye care system. Lessons learnt Our findings highlight the importance of engaging services and stakeholders to ensure a systems approach that is evidence‐informed, contextually appropriate and reflects commitment to improved eye health outcomes.