ABSTRACT
BACKGROUND: Patients in rural Australia have limited access to intravitreal treatments due to a maldistribution of the ophthalmology workforce. To improve access, a novel outreach service model was implemented whereby junior medical staff administered intravitreal injections under a supervising ophthalmology consultant. This model involves outreach visits in hospitals, mobile clinics and a remote hub with intravitreal injections administered by junior doctors overseen by an ophthalmologist. The article explores the safety of this approach with respect to the rate of post-injection endophthalmitis. METHODS: A retrospective audit was conducted by the Lions Outback Vision outreach ophthalmology service from 2017 to mid-2023. The number of injections, locations, diagnoses, intravitreal agents used, designation of administering doctor and cases of endophthalmitis were reviewed. RESULTS: A 12 632 intravitreal injections were administered across 32 locations throughout rural Western Australia in the 6.5-year period. Three cases of endophthalmitis occurred representing a rate of 0.0237%. CONCLUSION: The rate of endophthalmitis in the outreach service is comparable to other centres. The outreach model with supervising ophthalmology consultant support in person or via telehealth and administration of injections by junior medical staff has improved access for underserved or marginalised populations.
ABSTRACT
PROBLEM: Despite its potential to improve service provision for country patients, teleophthalmology is currently underused in Australia. There is an associated lack of cost-effectiveness data for teleophthamology. DESIGN: Retrospective and prospective hospital-based clinical audits of 5456 patients; descriptive survey of available telehealth equipment in 129 regional facilities; cost calculations for teleophthalmology, patient transfers and outreach services. SETTING: Primary (optometry, general practice [GP], Aboriginal Medical Service [AMS]) and secondary (hospital) sites in regional Western Australia; a tertiary hospital in Perth. KEY MEASURES FOR IMPROVEMENT: Proportion of patients suitable for teleophthalmology; proportion of regional practices with telehealth technology; capital expenditure to equip regional practices for teleophthalmology; total savings from increased utilisation of teleophthalmology. STRATEGIES FOR CHANGE: Advocacy for funding, regulatory, training and infrastructure recommendations, in order to support efficient models of teleophthalmology. EFFECTS OF CHANGE: A total of 15% and 24% of urgent patient transfers and outreach consultations, respectively, were found to be suitable for teleophthalmology, equating to a potential total cost saving of $1.1 million/year. Capital expenditure required for basic telehealth equipment was negligible for optometrists, compared to $20 500 per GP/AMS practice. Successful advocacy led to funding, training and policy changes to support optometry-led teleophthalmology for country patients in Australia. LESSONS LEARNT: Public-private partnerships can result in significant cost-savings for the Australian health system. Targeted, evidence-based advocacy can inform government health reforms.
