ABORIGINAL SPECTACLES PROJECT

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ABORIGINAL SPECTACLES PROJECT
Aboriginal Eye Health Workshop 20 June 2005
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• Evaluation of the ICEE
• VisionCare NSW Program

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Aboriginal people in NSW

• NSW Aboriginal population
• 120,000 -135,000
• 28 of Australian Aboriginal population
• 7X level of blindness from preventable eye
  disease than the non-Aboriginal population
• Life expectancy 20 years less
• 5X higher infant mortality
• 8X higher diabetes death rate
• Low usage of mainstream health services

Australian Bureau of Statistics, Canberra, ABS
2001, Ring Brown (2002)
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Barriers to Service

• Limited accessibility of optometric services
• Lack of Transport
• Lack of Awareness
• Patients per optometrist
• 1,180 national average
• 2,700 in rural areas
• 12,700 in remote areas
• Culture
• Cost

Madden et al (2002) Wildsoet Wood
(1997) McDermott et al (1998)
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Refractive services in NSW

• ICEE/VisionCare NSW clinics are solely for the
  benefit of Aboriginal people
• 11 other service providers may service 30
  Aboriginal community locations ? number of
  Aboriginal people using these services unknown
• One mobile optometrist service ? 2200 pairs of
  spectacles dispensed to Aboriginal people

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ICEE VisionCare NSW Program

• Aims
• Improve indigenous peoples access to spectacles
• Reduce the incidence of uncorrected refractive
  error

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Stakeholders in the Program

• Aboriginal people
• The Aboriginal Health Medical Research Council
  (AHMRC) ? coordinator and participant
• Aboriginal Medical Services (AMSs) ? delivery
  access point and participant
• OATSIH ? facilitator

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Stakeholders in the Program

• The International Centre for Eyecare Education
  (ICEE) ? service delivery facilitator
• VisionCare NSW ? contractor
• NSW Government Rural Aerial Health Service ?
  assistance
• Commonwealth Medicare ? provision of funding
• The Royal Flying Doctor Service (RFDS)

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ICEE VisionCare NSW Program
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Overcoming the Barriers

• Limited accessibility of optometric services
• Eye Health Coordinators (EHCs) conduct screening,
  organise clinics and ensure people are aware of
  clinics
• Posters at community centres and clinics
• Patient recruitment through self-referral,
  medical practitioners and EHC screening
• Mobile services to small and remote community
  centres
• Access to ophthalmologists at regional hospitals
• Cooperation of GPs and other key health personnel

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Overcoming the Barriers

• Culture
• Aboriginal community control
• local Aboriginal community
• Aboriginal Community Controlled Health Services
  (ACCHSs)
• Eye Health Coordinators (EHCs) build
  relationships
• Consumer friendly spectacle scheme application
  form
• Use locally-based ICEE optometrists that work
  from the Aboriginal community controlled premises

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Overcoming the Barriers

• Cost
• Eye examination is free of charge to the patient
• Spectacles are provided through VisionCare NSW

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DATA ANALYSIS
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STUDIES ICEE

• 26 clinics
• 2517 consultations
• Variables collected (Y/N)
• Rx required
• Visioncare Specs
• Diabetes
• Retinopathy
• Glaucoma
• Cataract
• Referral Ophthal, Optom, GP
• Previous eye exam

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STUDIES VisionCare NSW

• 2544 Spectacle orders
• 1 service provider
• Variables collected
• Lens Power
• Lens type
• Previous eye exam

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STATISTICS

• Vision Care Delivery indicators eye conditions
• compared as a percentage between categories using
  chi-square or Fishers exact test
• Duration in years since last eye exam
• was compared between categories of each
  demographic factor using t-test or ANOVA with
  post-hoc adjustment using Tukey corrections
• Statistical significance was set at plt0.05

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ICEE DEMOGRAPHICS Age Gender
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ICEE DEMOGRAPHICS Location
The Rural, Remote and Metropolitan Area (RRMA)
classification system, Australian Government
Department of Health and Aging
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ICEE LOCATION DEMOGRAPHICS
P0.05
N738
N375
N1280
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ICEE LOCATION DEMOGRAPHICS
P0.1
N743
N378
N1323
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SPECTACLE CORRECTION

• 3/4 needed spectacle correction
• 71 ordered VisionCare specs

N2452
P0.00

Age (years)
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PREVIOUS EYE EXAM

• 1/5 had never had an eye exam

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PREVIOUS EYE EXAM

• Least likely to have had an eye exam
• 018 year olds
• Men
• Rural
• ? 40

P0.00

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DIABETES
Prevalence of Diabetes (22) (self reported)
N2452

Age (years)
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RETINOPATHY

• Most prevalent ocular disease (5.4)

p0.04
Urban, N738 Rural town, n375 Rural n1280
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OCULAR DISEASE

• Cataract 4.4
• Glaucoma 0.8

p0.00
Urban, N738 Rural town, n375 Rural n1280

Eye Disease
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REFERRALS

• Ophthalmologist 4.3
• GP 2.8

Urban, N738 Rural town, n375 Rural n1280
p0.00

NS
Eye Disease
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LENS POWER
N2544
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LENS POWER
N2544
P0.00
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NUMBER OF SPECTACLES ORDERED
PATIENTS ORDERING 2 PAIRS OF SPECS
N2544
P0.00
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LENS TYPE
N2544
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VISIONCARE NSW SPECS
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VISIONCARE NSW SPECS

• Since its inception, the Program has provided 10,
  000 spectacles to Aboriginal people over a five
  year period.
• It is estimated that 20 (24,000) of the NSW
  Aboriginal population require spectacles due to
  refractive error
• Last year the Program provided 2422 spectacles to
  Aboriginal people.

B Layland, 2004 VisionCare NSW Annual Report
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OUTCOMES

• Create Eye Care awareness
• Target
• Younger population for regular eye checks
• Rural men over 40 for regular eye checks
• Screen 19-39 year olds for retinopathy
• Increase service coverage
• More areas
• Extend operating hours

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PROGRAM IMPROVEMENTS

• Population study
• Prevalence of refractive error (corrected
  uncorrected)
• Prevalence of ocular disease
• Barriers to eyecare
• specific to NSW Aboriginal communities
• Eye Health knowledge
• Identify populations in need

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PROGRAM IMPROVEMENTS

• Data collection system
• Add fields to data form
• Patient no
• Prescription purpose
• Presenting reason
• How did they find out about clinic
• Patient satisfaction survey
• Redfern administrator computer

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PROGRAM IMPROVEMENTS

• Educate Eye Health Coordinators
• Educate new EHCs
• Provide ongoing EHC education
• Conduct more school community screenings
• Employ an EHC for Sydney

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FUTURE DIRECTIONS

• Meeting the need
• Sustainability
• Model for expansion
• NSW
• Australia

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