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A Summary of the Queensland Health funded project to develop a
“Strategy and Implementation Plan for the prevention of vision loss and provision of eye care for Indigenous Queenslanders”
In November 2007, QVI was awarded a grant from the Queensland Government to investigate ways to improve eye care services for the Indigenous population in Queensland. This project was completed in 2009, and a “Strategy and Implementation Plan to Improve Eye Health Service Delivery to Indigenous Queenslanders was submitted to the Queensland Government” in March 2009.
Historically, there have been a number of barriers to provision of Indigenous eye health services in Queensland, and there has been limited data available on the effectiveness of current services across the State. In 2008, two hundred and eighteen eye and allied health professionals were, therefore, enrolled in this study and surveyed to evaluate current eye health practices, issues and recommendations for the improvement of services across the State. As can be seen in the table below, over half of those surveyed work directly with people of Indigenous descent, and although many eye health professionals (optometrists, ophthalmologists and low vision workers) are based in metropolitan or regional centres, many also provide services to rural and remote regions via outreach programs.
In this study, a third (36%) of the optometrists surveyed provide outreach services, and half visit Indigenous communities and Aboriginal Medical Services (AMS) or Aboriginal Community Controlled Health Organisations (ACCHOs). These outreach visits are conducted from once a year to once a week; the rest of these optometrists see Indigenous clients at their own practice. Seventy nine percent of the ophthalmologists surveyed, also provide outreach services to rural and remote regions of the State, most visiting between 1-12 times per year. Four of the orthoptists surveyed work with Indigenous people, and they travel out to provide services in regions around Brisbane, Cairns, Townsville and Palm Island. Six low vision workers surveyed also provide vision-related services to Indigenous Queenslanders, services such as orientation and mobility training, occupational therapy and speech pathology services. Most (67%) are based in Brisbane (one in Cairns) and visits are provided across the State depending on each client’s needs (some travel as far as Far North Queensland).
Of the allied health professionals, most GPs see Indigenous patients locally in GP/medical practices, Aboriginal Medical Services and Aboriginal community controlled health centres or in a hospital. Eight health workers and one diabetic educator surveyed also work in Aboriginal and Islander Health Services, Islander Medical Centres or communities. Others are based in metropolitan, regional and rural or remote regions of Queensland. Five pharmacists surveyed also work with people of Indigenous descent, mostly as part of the QUMAX program.
As expected, all of the ophthalmologists surveyed perform full eye examinations and 86% provide laser treatment. All of the optometrists, surveyed and providing Indigenous eye care perform full eye examinations and over half provide low vision services. Most orthoptists also perform full eye examinations and half are involved with laser treatment provision and provide low vision services. Most GPs provide care for minor eye problems, triage, with referral to eye specialists as appropriate, and most (42%) provide full eye examination with vision screening
Survey participants working with Indigenous and non-Indigenous people, identified the same barriers to Indigenous eye care services in Queensland. These are:
1. Lack of education regarding prevention of eye health conditions
2. Clients unable to access services because of transport issues
3. Lack of a consistent, clear, culturally appropriate eye health message being received by Indigenous Queenslanders
And the following key recommendations were made for improvement of Indigenous Eye Care services:
1. Produce targeted and culturally appropriate education campaigns regarding eye health issues
2. Increase visits to ATSI communities from eye and allied health professionals
3. Increase numbers of Regional Eye Health co-ordinators and ATSI health workers
Seven recommendations were submitted to Queensland Health, along with the Strategy and Implementation Plan for Improved Eye Care Services for Indigenous Queenslanders. These are:
1. QVI (and the QVI working group) to be supported and funded by the Queensland Government to adopt an advisory role, to liaise with eye health professional organisations, government and non-government organisations and Indigenous groups to develop, monitor and evaluate solutions to eye care issues.
2. Targeted eye health education resources to be distributed to Aboriginal and Torres Strait Islander communities: to promote awareness of eye diseases and low vision services, including information regarding Medicare services and the MASS spectacle supply scheme. Information to be provided by radio programs (such as the Murri radio), TV and print media, with culturally appropriate literature for each group. (A target 20-50 year age group is recommended – especially those with a family history of diabetes).
3. Increased support and training for Indigenous health workers and regional eye health coordinators (REHCs), to promote delivery of eye health services in a supportive primary healthcare environment.
4. Successful programs and models of eye care services to be recognised by Government, with such models of care to be considered for replication in other areas of Queensland; such as the Cape York model for outreach services.
5. Partnership options between the eye and allied health sector to promote eye care services as part of an integrated primary health care system to be explored (especially low vision and rehabilitation services).
6. Reduced gaps and duplications of service, and adequate equipment to be made available, with funding for servicing and repair as required.
7. An information kit for eye and allied health professionals to be produced and distributed (including resources already available): plus information on cultural awareness issues, Medicare services, the MASS spectacle supply scheme, and low vision services.
Over the last thirty years since the work of Fred Hollows, much has been achieved in provision of eye health services for Indigenous Australians. And in this study, a number of recommendations have been made to help ‘close the gap’ between eye health in Indigenous Queenslanders and the rest of the Queensland population. These recommendations involve: effective and appropriate eye health education for Indigenous people to promote an awareness of eye health and vision care; support and sufficient funding of successful eye health programs, eye health staff, and replication of these programs in areas of need; and the effective monitoring and coordination of eye health services across all Government and non-government agencies with an interest in vision care.