Victorian ophthalmology service planning framework

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26 Victorian ophthalmology service planning framework To ensure equitable and appropriate access to public outpatient services and elective surgery, the department has developed two elective surgery management policies which outline how elective surgery waiting lists are to be managed. These documents are called Elective Surgery Waiting List Referral Policy and Elective Surgery Access Policy and are available online at www.health.vic.gov.au/elective surgery. Recommendation 1. Develop consistent guidelines and practices for accessing public ophthalmology outpatient services and elective surgery to ensure that access is equitable, appropriate and based on clinical need. Eye care literacy Access to information about a particular condition is important in any high quality health care system as it empowers the patient and carer to make well informed decisions about their health and course of treatment. Access to information also enables consumers to gain a better understanding of the role of different health care professionals and to seek appropriate care pathways. Stakeholders suggested that current eye care information was not reaching as many people as it should be. Evidence suggests that many people on low incomes do not prioritise eye care and are unaware of the benefits of a regular eye examination. Moreover, many patients, particularly the elderly, were said to be unaware that their vision is capable of correction, or do not want correction. Inadequate monitoring of conditions such as diabetes, reflects a lack of patient awareness of the need for services, or poor referral practices, rather than a lack of available services. Consumer consultation also confirmed that consumers generally have only a vague understanding of the distinction between the roles and responsibilities of various ophthalmology professionals and ophthalmology support services. This situation was reinforced by the experiences and perceptions of consumer representatives: ‘A lot of the consumers get confused what people’s roles are. They get conflicting messages…’ Consumers, however, were more able to identify the functions performed by optometrists than those of other eye professionals. Through improving access to, and promotion of, eye care information, consumers will be able to make more informed decisions about their health. The Vision Initiative is an eye health promotion and education program that aims to reduce the incidence of preventable blindness and the impact of severe vision loss.
Victorian ophthalmology service planning framework 27 Referral pathways Just as it is important for patients to understand their condition so they can make informed decisions and seek appropriate care pathways, it is important that health professionals understand the roles of other health professionals and services available so that they can make the most appropriate referrals. Concerns were raised about variations in referral pathways and the appropriateness of some referrals by eye care professionals. For example, some patients are referred to tertiary public hospitals for refraction and routine eye examinations rather than to community providers such as optometrists and the VES. Variations in referral pathways were suggested to be due to a lack of understanding of the roles of different eye care professionals by other health care professionals and consumers, and the fragmentation between certain professional groups. The fragmentation was seen to be due to inherent professional boundaries and traditional factors. Referral to low vision services was also highlighted as an issue. Low vision services aim to optimise vision and provide aids and assistance to improve quality of life to people with permanent low vision. Providers believe that improved referral to low vision services is required, given that utilisation rates for low vision services are universally low. Estimates indicate that between only 5–10 per cent of people with low vision use low vision services (Pollard et al, 2003). This concern was echoed by consumers who, in general, believe that ophthalmologists (and, to a lesser extent optometrists) have a narrow perspective on treatment options for people diagnosed with eye conditions, especially those conditions which are ongoing or incurable. Other barriers to accessing low vision services identified in the literature include awareness of services among the general public and eye health professionals, understanding of low vision and the services available, acceptance of low vision, the referral process, and transport (Pollard et al, 2003). Education, pre-admission clinics and evidence-based guidelines are methods to increase appropriate referrals. These methods are supported by stakeholders, and work is already being done by the Vision Initiative to educate eye health professionals to promote best practice. Recommendation 2. Improve eye health education and promotion programs for consumers and providers through support of the Vision Initiative.
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