Referral Pathway Pilot Project Summary

The Problem

A number of reports have highlighted the increased prevalence of low vision in Australia, and the potential for 75% of this vision loss to be prevented or corrected through early detection and the appropriate treatment. In fact the number of Australians with significantly reduced vision is now reported to be half a million, or approximately 2.5% of the population and this figure is predicted to double over the next twenty years. In 2005, five key areas for action to reduce the incidence of blindness and vision loss in Australia were put forward by the National Eye Health Framework report. These were to reduce the risk, increase early detection, improve access to eye health services, improve systems and quality of care and to improve the evidence base.

This Project

In September 2007, the Queensland Vision Initiative Inc. (QVI) was awarded a National Eye Health Initiative Demonstration grant, with the aim of improving the coordination, quality and delivery of eye healthcare services in metropolitan Brisbane. This pilot project was designed to address some of the issues raised in the National Eye Health Framework report. With representation from the QVI, vision-related organisations and low vision agencies a QVI working group was established in November 2007. Since this time, collaboration within the eye care sector has been promoted through; regular meetings of project partners, development of an information resource, regular attendance at professional education events and information gathering by individuals and organisations.

Review

Many previous reports on low vision services and referral pathways in Queensland or Australia are outdated, but two articles from 1996 highlight low rates of referral or late referrals to low vision and support agencies. In addition, an audit of currently available eye health and vision care resources, revealed that although a wide range of print and web-based information resources are available, many are not up-to-date and few are tailored to promote services to health professionals. There is also little information regarding the importance of regular eye examinations.

Awareness

To raise awareness of the services provided by low vision and community organisations in Brisbane and the importance of vision care; QVI undertook to promote these services to healthcare professionals. Information from a variety of low vision agencies and support groups (including demonstration of low vision devices and assistive technology equipment) has been provided to hundreds of delegates at eight professional education events. In addition, a flyer outlining the hours of operation and services of Brisbane’s five low vision clinics has been distributed and a broadcast on low vision services in Queensland transmitted to 150 Queensland Health Hospitals and facilities in February 2009.

Referral Pathways

An information resource for eye and allied health professionals was developed and produced in 2008, to improve awareness of the roles of eye care practitioners and appropriate referral pathways, and to detail services provided by low vision agencies and community organisations. The directory was distributed throughout 2008-2009 through professional organisations and low vision agency networks, at health professional workshops and education events for optometrists, ophthalmologists, ophthalmic nurses, pharmacists and low vision workers.

Referral Practises

A scoping exercise was also undertaken in 2008 to examine referral pathways between health care practitioners, low vision agencies and community organisations. Survey were distributed to eye and allied health professionals including: optometrists, ophthalmologists, ophthalmic nurses, GPs, pharmacists, orthoptists and low vision services employees through QVI’s network of professional organisations. The survey was developed to improve the evidence base for current referral practices in Brisbane, and also to identify opportunities to improve practitioners’ awareness of low vision agencies, rehabilitation and support services. In total, 96 participants enrolled in the study including:  62 optometrists, 8 ophthalmologists, 9 pharmacists, 3 ophthalmic nurses, 8 low vision practitioners, a diabetic educator and 5 GPs. The results of the survey are summarised below.

Survey Findings

1. The findings of this study suggest most eye health practitioners are referring patients with low vision to low vision clinics appropriately, however, referrals to peer support groups and community organisations by optometrists and ophthalmologists are low, and many eye health professionals are still unaware of the services provided by each agency. Late referrals may also be an issue.

2. Overall all eye health professionals appear to be promoting regular eye checks to their patients and clients, and many provide information resources regarding eye health. However, there are still significant numbers of eye and allied health professionals who do not know what services are provided by each agency, especially pharmacists, who are in the community and ideally placed to promote vision care.

3. The main issue identified by almost two thirds of respondents as a barrier to eye health and low vision services, is a lack of awareness of the services provided by each agency.

4. Other issues were also identified: Over half of the low vision practitioners reported that it took too long to get appointments (with two individuals specifying that ophthalmologist and low vision clinic waiting lists are too long); a third of optometrists reported that no information was received back from agencies regarding their referrals; and the cost of transport and vision aids were highlighted.

5. A third of low vision practitioners reported gaps in services. Some optometrists and low vision practitioners also thought there was duplication of service provision - though this did not appear to be a significant issue in Brisbane.

6. Two thirds of the study participants recommended: continuing education for eye and allied health professionals regarding low vision and community organisations and a website to detail the services available. Almost a third of respondents also recommended provision of electronic referral systems and more information regarding the importance of regular eye checks. Lack of information in this area was identified as an issue in an audit of information resources available.

Conclusion

The Referral Pathway Pilot Project undertaken by QVI addresses many of the issues raised in this report. QVI has developed a directory of vision-related organisations in Brisbane, which includes relevant and up-to-date contact details, a summary of services provided and referral procedures. Distribution of the information has been well received and the information has also been made available on the new QVI website. In addition, promotion of low vision services has been made at professional education events, a flyer of low vision clinic services in Brisbane has been produced and distributed and a broadcast on low vision services in Queensland was transmitted to 150 Queensland Health Hospitals and facilities.

Some of the issues raised are also being addressed by low vision agencies. For example, information regarding referrals is provided on request by the Vision Australia Low Vision Clinic. In addition, Guide Dogs Queensland has an electronic referral system in place. In addition, the federally funded National Eye Health Campaign for 2009 introduced May 1, will also help to promote awareness of eye health in the community.

Sustained promotion of the services provided by different low vision and rehabilitation agencies, support groups and community organisations, and the benefits of early referral, is still required; through continuing education for eye and allied health professionals and a website detailing the services available. Community awareness of vision care, regular eye checks and the availability of low vision services also needs to be promoted, and this should include community based centres, such as pharmacies. Gaps in low vision services also need to be identified to ensure access to services for those with low vision or blindness.

This project was generously supported by a National Eye Health Initiative grant from the Department of Health and Ageing.