Measuring the appropriateness of eye care delivery in Australia

Defining existing practice patterns and current variation from best practices are essential to improve quality of eye care. This thesis aims to measure the appropriateness of eye care delivery in Australia with a comprehensive approach assessing multiple conditions at a practice level. Record review was chosen to measure the appropriateness of eye care with its relative low cost and availability of data. A high concordance was shown between record review and the more expensive gold standard technique of standardised patient simulation in assessing the appropriateness of eye care in an Australian university-based optometry practice. A sample of 1260 patient records (from 2013 to 2014) of a random stratified sample of 42 optometry practices across four Australian states (New South Wales, Queensland, Victoria and South Australia), representing a cross-section of adult Australian population, were reviewed against 94 clinical indicators for preventative, glaucoma and diabetic eye care. The clinical indicators were developed from national and international evidence-based clinical practice guidelines and clinical experts using the Delphi method. This approach was initially piloted to evaluate the feasibility of onsite record review to identify the logistic problems and to determine the best sampling strategy, using a small sample of eye care practice from diverse settings. The percentage of appropriate eye care was measured and the potential for selected patient and practice factors to modulate appropriateness of eye care was investigated. Appropriate eye care was received by Australian patients at an average of 71% of eligible encounters. The percentage of appropriate eye care for preventative eye care was 81%, glaucoma was 63% and diabetic eye care was 69%. Clinical indicators with compliance less than 20% for preventative eye care included documentation of ethnicity, habitual near VA; those with poor compliance for glaucoma care included documentation of ethnicity, steroid use, low blood pressure, Raynaud’s syndrome, side effects of ocular medication and optic disc size. Better structuring of patient records might help to facilitate the delivery of appropriate care. Future educational interventions can be targeted to address areas where the poorest compliance was measured. Regular record review may be used to evaluate the effectiveness of any interventions