Needs Assessment and Activity Plan for the VicOutreach ...€¦ · Contents Contents ... Verifying data, service plans and gap analysis ..... 21 3. Recommendations for VOS services

Needs Assessment and Activity Plan

for the VicOutreach Optometrists

Scheme in Victoria

July 2015

Contents

Contents ................................................................................................................................................................... 2

Executive summary. .............................................................................................................................................. 3

1. Background and methodology ......................................................................................................... 8

Eye health and the eye care workforce in Victoria ................................................................................. 8

The VicOutreach Optometrists Scheme .................................................................................................... 8

Evaluation of the VOS program ................................................................................................................... 9

Needs assessment methodology .............................................................................................................. 10

About this report ........................................................................................................................................... 12

2. Understanding optometry needs in rural and regional Victoria ............................................ 13

What the data told us about need ............................................................................................................ 13

What the consultations told us about need ........................................................................................... 17

Identifying important themes with key stakeholders .......................................................................... 18

Verifying data, service plans and gap analysis ...................................................................................... 21

3. Recommendations for VOS services in Victoria ......................................................................... 25

Unmet service needs in Victoria ................................................................................................................ 26

Efficiencies in outreach ................................................................................................................................ 27

Urban VOS services ....................................................................................................................................... 29

Final remarks .................................................................................................................................................. 31

July 2015 Needs assessment for VicOutreach Optometrists Scheme Page 3 of 32

Executive summary.

1. Background and methodology

This needs assessment identifies priority locations for VicOutreach Optometrist Scheme (VOS) services,

including those specific to Aboriginal populations, by considering gaps in service delivery at the

jurisdictional and local level, while taking into account capacity to sustain outreach services, potential

linkages between VOS services and existing primary care services and other visiting health professionals.

The needs assessment methodology involved: (i) analysing data on priority eye health domains and

service access data, (ii) ranking and prioritising data to establish a heat map of service need, and (iii)

consulting with key and local informants to verify need and assess feasibility for service.

2. Understanding optometry needs in rural and regional Victoria

The needs assessment drew on the best publicly available data, while acknowledging its limitations, and

results should be considered an estimate of need. The data analysis was limited to the health and

demographic data in the public domain. Aboriginal and Torres Strait Islander patient identification in

primary care remains under-reported1 and there is no publicly available health indicator data at Victorian

LGA level due to the small number of records in the 2011 Census.

The desktop analysis was conducted over a one month period over May – June 2015. The process

included:

Analysing demographic and health status data by local government area (LGA) in the priority health

domains of eye health, eye health behaviours and diabetes

Analysing available data on eye health determinants and most-at-risk populations: people over 40

years, smokers, people with diabetes and Aboriginal and Torres Strait Islander populations

Analysing the Indigenous Eye Health Unit Eye Care Workforce Calculator and service access and usage2

in rural communities, including Medicare Benefits Schedule (MBS) data, and assessing optometry

practice density by geographic area

Mapping current VOS service delivery models (including private providers and Australian College of

Optometry) and current VicOutreach service delivery data

Ranking and prioritising data to establish a heat map of service need through a gap analysis of LGA

locations by eye health need against current outreach optometry services (VOS, RHOF, MOICDP) and

location RA category, in order to establish priority service locations.

Key findings relevant to the delivery of outreach optometry and other eye health services across rural

Victoria arising from the data analysis include:

In the Campaspe, Mitchell and Queenscliff LGAs, significantly higher proportions of people had

never seen an eye health professional, compared with all Victorian adults.

1 Data on Aboriginal eye health in Victoria: what comes out is only as good as what goes in (2014) 2 Service usage data for VOS will not be available to inform the 2015-6 service plan.


Darebin, Greater Geelong, Greater Shepparton and Latrobe LGAs have a higher proportion of

people aged over 40, smokers, people with diabetes and people of Aboriginal and Torres Strait

Islander descent. A large number of residents do not have regular eye tests, putting them at

increased risk of eye disease.

Proportions of Victorians reporting visiting an eye professional in the last six months were

significantly lower in rural Victoria than metropolitan Melbourne.

There were no significant differences between metropolitan and rural areas in the proportion of

people who had noticed a change in their vision; the prevalence of glaucoma, diabetic retinopathy

or macular degeneration.

The prevalence of macular degeneration was significantly higher in men and adults who lived in the

Gippsland Region compared with all Victorian men and adults, respectively.

A higher proportion of people living in rural Victoria wore both a hat and sunglasses than those in

metropolitan locations.

There is a relationship between declining socio economic status and change in vision, sun-

protective behaviours and people who had never seen an eye professional.3

In western Victoria there are fewer practices per million of population and several postcodes in the

north-west are without a practice. It is important to note that practice density does not capture

other access barrier issues and can only contribute to an overall picture of service planning needs.4

More than one in eight (12%) comprehensive examinations were for children aged 14 and under

and more than one in three (33.5%) for Victorians aged over 55 years.5 Of note, Victoria’s per capita

use of ‘comprehensive eye examination’ MBS billing is below the national average, and behind

NSW, Queensland, WA, SA, Tasmania and the ACT.

Over an eight-week period from May – July 2015, RWAV consulted with stakeholders using semi-

structured interviews and an online survey. Four key stakeholder groups were consulted: the Koolin Balit

Aboriginal Eye Health Advisory Group, Australian College of Optometry, local Aboriginal, community and

district health services, and current VOS service providers, to:

Validate the service needs identified through the data, identify existing health services to address

needs and service gaps and assess the current VOS outreach services according to community need

Establish whether the eye health service mix established under VOS, MOICDP and RHOF is responding

to the current health needs and trends.

Key themes to relevant to the delivery of outreach optometry and other eye health services across rural

Victoria arising from the consultation include:

3 See the full Victorian Population Health Survey 2011-12 report for a more detailed discussion 4 ACIL Allen Consulting, Optometry Market Analysis, 2014 5 Optometry Australia


Integration of eye health services:

A number of schemes and eye care services currently support eye health in Aboriginal community

members: the VOS, VicOutreach Aboriginal Health, and the Victorian Aboriginal Spectacle Subsidy

Scheme (VASSS).

There is currently no systematic statewide approach to determining eye care need and

coordinating care in Victoria, rather there are multiple site-based approaches determined by

patient lists rather than population-level data on health need.

The Victorian Government has implemented one statewide and four regional Indigenous eye health

projects to develop and strengthen regional networks and improve coordination and referral

pathways.

Eye health services for Aboriginal and Torres Strait Islander communities:

The ACO provides optometry services through the VOS and VicOutreach Aboriginal Health to 18

Aboriginal Community Controlled Health Organisations (ACCHOs) in rural and metropolitan

Victoria.

ACCHOs identified people living with diabetes, health promotion days, kindergarten children,

middle-aged people and elders as priorities for eye care.

ACCHOs receiving outreach services reported high satisfaction with the ACO and stated the

frequency of current visits is meeting need. Some ACCHOs reported successfully integrating the

VOS service into overall health services as a tool for timely diagnosis of other disease, emphasising

that fortnightly visits (rather than monthly) embeds eye care into routine visits with the diabetes

educator and chronic disease nurse.

However, many of the 22 ACCHOs consulted reported high numbers of patients with diabetes and

other chronic diseases and full waiting lists for optometry appointments and the data showed long

waiting times for eye examinations.

The unmet needs in Aboriginal and Torres Strait Islander eye health are similar in urban and rural

areas and RWAV’s consultations revealed that unmet needs for Melbourne communities are in eye

care coordination and service linkages rather than geographic access to optometry consultations.

Eye health services for the broader population:

Consultations with 22 local community and district health services highlighted that few of the

community health informants collected relevant concrete data on eye health.

Informants identified ageing populations, residential aged care facility residents, people living with

diabetes and schools as priorities for eye care.

Risk factors identified include small, and largely ageing, populations with high incidence of age

related chronic disease.

Service access barriers such as large geographical catchments with small outlying towns, few

transport options and limited access to services mean that people have to travel long distances for

eye care.


In some cases, a low socioeconomic profile that overlapped with high numbers of pensioners and

people living with disability mean that local community services find it difficult to monitor and

support patients’ eye health and that the cost of spectacles is seen as prohibitive.

Three community health informants reported an optometrist providing outreach in a private

capacity at the local town. Lack of integration with local services (and lack of access to data on eye

health) and the reliance on a single provider who, in some cases, did not offer any subsidised

schemes, were reported as challenges for these optometry services.

3. Recommendations to inform VOS service delivery in Victoria

To identify priority locations for VOS services RWAV has considered the key layers of data on eye health

and services in Victoria, the current VOS service delivery plan, estimates against the workforce needs

calculated by IEHU and indicators of community verification. LGAs were compiled and sorted by priority

based on a collective analysis of data and consultation, and prioritised according to the following:

Priority 1 Priority 2 Priority 3

RA4

Never seen an eye professional

LGA top 4 priority areas (based on age,

smoking, diabetes, size of Aboriginal

population, regular eye tests)

3+ indicators of high need

>50km away from optometry service

2011 VOS prioritisation

High need for regular eye tests (e.g.

priority score on 2 service access

categories), in RA3 or greater

Identified for priority by informant,

requires further investigation

High Aboriginal population, no service

RA3 and any

indicator of need

RA2 with 3 indicators

of need

All RA3 locations not

being serviced

This activity identified 46 rural LGAs and 15 metropolitan sites as priority locations (see table below) with

either no current optometry service access or where the frequency of VOS services could potentially be

increased.

LOCATION PRIORITY LOCATION PRIORITY

For consideration for new VOS service For review of existing VOS service frequency

Timboon 1 Hamilton 1

Cobden 1 Rainbow 1

Boort, Pyramid Hill, Mitiamo, Wedderburn 1 Omeo, Benambra 1

Corryong 1 Mildura 3

Mooroopna 1 Echuca 1

Broadford, Kilmore, Seymour 1 Swan Hill, Kerang 2, 3

Mansfield, Tolmie, Merrijig, Jamieson 1 Wodonga 3

Benalla, Glenrowan, Mollyullah 1 Bairnsdale 1

Cobram, Yarrawonga, Numurkah 1 Lake Tyers 2

Foster, Leongatha, Fish Creek 2 Ouyen 1

Euroa, Violet Town, Nagambie, Ruffy 3 Gelantipy 1

Minyip 3 Alpine 1




Edenhope 3 Heywood 2

Framlingham 2

Orbost 2

Lake Tyers 2

Jeparit 3

The 2011 evaluation of the VOS recommended aligning optometry outreach with other outreach eye

health services. Anecdotally, a previous lack of co-ordination between the outreach services delivered

through VOS, MOICDP and RHOF has led to duplication (for example in eye exams, refraction

assessments). Adequate population level service planning in rural and regional Victoria is needed to

ensure the appropriate level of service, in the right region, in the right sequence, with the right frequency.

The RHOF, MOICDP and VOS outreach programs need to be better integrated but further data collection

analysis is required to best shape this integration, which was beyond the scope of this needs assessment.

4. Service delivery plan

RWAV's new statewide fundholder arrangement provides an opportunity to implement a coordinated and

integrated service model and the focus for the program for the coming year is to apply consistent funding

and reporting rules across all Victorian outreach programs, maintain established VOS services and address

priority areas of need.

Each of the existing VOS sites continue to exhibit a need for outreach services and RWAV will continue all

the existing services for twelve months. This will allow a complete data set for the current services to be

collected and any issues identified and reviewed.

The needs assessment identified eight Victorian locations with little access to optometry services and high

levels of need. The proposed visiting frequencies were informed by consultations, demographic data,

comparison to other VOS services, and budget. The following locations are prioritised for services:

Location Frequency Location Frequency

Boort/Pyramid Hill Monthly Euroa/Nagambie Monthly

Mansfield Monthly Timboon-Cobden Monthly

Benalla Monthly Foster Monthly

Seymour Monthly Edenhope Monthly


1. Background and methodology

Eye health and the eye care workforce in Victoria

Vision problems and eye disease are amongst the most common health complaints within Australia, and

in 2004, the total cost of vision impairment and blindness in Australia was reported to be $9.85 billion.6

Recent estimates indicate vision loss currently affects nearly six per cent of Victorians aged over 40

(145,670 people), and without appropriate intervention, the number might increase to 201,000 by 2020.7

Around 80 per cent of vision loss in Australia is caused by five conditions, all of which become more

common as we get older. Importantly, around 75 per cent of vision loss is preventable or treatable. Vision

loss from diabetes, cataract and refractive error (the need for glasses) is also common in Aboriginal

communities in Victoria with 94% of vision loss preventable or treatable. Regular eye examinations, early

detection and treatment of eye problems help prevent vision loss.

Eye health services in Victoria are provided by a range of public and private service providers, including

GPs, optometrists and ophthalmologists in a range of settings. Optometry services provide primary eye

care examinations to check ocular health, visual acuity and refractive error, and may provide treatment for

minor eye conditions. In addition to identifying glaucoma, cataracts, diabetic retinopathy, optometrists

are able to prescribe and supply spectacles, contact lenses and some visual aids. Data from Optometry

Australia indicates that there were 1,200 optometrists in Victoria as of March 2014 (with 224 medical

practitioners specialising in ophthalmology).8 Optometry services in urban and rural areas are

predominantly private services, located where they are economically viable. While most large rural towns

have a local optometrist, practices for smaller towns and communities are not always viable.

Visiting or outreach services are provided in settings where access to mainstream services are limited.

While the majority of Australians can readily access an optometrist, significant numbers still experience

barriers in accessing services, particular those on low incomes, living in rural/remote areas, Aboriginal and

Torres Strait Islander Australians and those in residential aged care.9

The VicOutreach Optometrists Scheme

The VicOutreach Optometrists Scheme (VOS) supports optometrists to deliver outreach optometric

services to remote and very remote locations, and rural communities with an identified need.

The VOS emphasises service delivery in areas classified as RA3 to RA5. VOS-funded services can be

provided in RA2 areas that a needs analysis identified have additional needs. A fundholder can also

consider other options for providing culturally appropriate services for Aboriginal and Torres Strait

Islander patients in RA1 locations. Options include use of the MOICDP if the patient has an eligible

6 Access Economics 2010, Clear focus: the economic impact of vision loss in Australia in 2009. An overview of the report prepared

for Vision 2020 Australia by Access Economics Pty Limited, Access Economics, Melbourne. 7 Optometry Australia

8 Optometry Australia 9 Equitable Access to Optometric Care, Optometry Australia, 2015, www.optometry.org.au/media/590221/equitable_access.pdf

http://www.optometry.org.au/media/590221/equitable_access.pdf


chronic disease and linking with the Closing the Gap workforce employed through programmes such as

the Improving Indigenous Access to Mainstream Primary Care Programme.

Figure 1: Eligibility for VOS by remoteness area

RA Eligibility for VOS

1 Aboriginal and Torres Strait Islander

2 In case of identified need

3 Priority

4 Priority

5 Priority

Optometrists participating in VOS are provided with incentives and support that cover the costs of

delivering services in rural and remote areas. Costs reimbursed include but are not limited to: travel,

accommodation and meals, facility fees and an absence from practice allowance to compensate for ‘loss

of business opportunity’. Further detail is available in the Australian Department of Health Visiting

Optometrists Scheme Service Delivery Standards.

Evaluation of the VOS program

In 2011, the Australian Government commissioned an evaluation of the Visiting Optometrists Scheme,

and overall found that VOS is vital in providing support for outreach optometry services.10 RWAV’s needs

assessment methodology has drawn on the key recommendation that better mechanisms are required to

assess levels of need and gaps in access in local communities. VOS needs to develop services and allocate

funding to communities with the poorest level of access. Other recommendations this needs assessment

takes into account:

setting VOS planning benchmarks that reflect an appropriate level of outreach service provision for

localities of different population sizes

ongoing monitoring of VOS effectiveness through the creation of a small set of performance

indicators for the program

integrating Medicare data analysis with VOS program data and information on localities where

optometrists are in practice

taking account of population size, age structures and prevalence of diabetes in local communities

assessing and addressing the optometric needs of Aboriginal and Torres Strait Islander people

residing in urban and inner regional areas

addressing under- and over-servicing seen in various communities

aligning optometry outreach with other outreach eye health services

10 Health Policy Analysis. 2011. Evaluation of the Medical Outreach Assistance Program and the Visiting Optometrists Scheme – Final

Report. Department of Health and Ageing. Canberra.


improved sharing of information between outreach eye health providers (VOS optometrists,

ophthalmologists and others), primary care health services and communities.

This needs assessment report contributes to a more comprehensive and open approach to planning and

developing services, allowing new VOS funding to be targeted at regions and communities with the

highest levels of need.

Needs assessment methodology

This needs assessment identifies priority locations for VOS services, including those specific to Aboriginal

populations, by considering gaps in service delivery at the jurisdictional and local level, while taking into

account capacity to sustain outreach services, potential linkages between VOS services and existing

primary care services and other visiting health professionals.

The needs assessment methodology involved: (i) data search and analysis on priority eye health domains

and service access data, (ii) ranking and prioritising data to establish a heat map of service needs, and (iii)

consultation with key and local informants to verify need and assess feasibility for service.

1. Data search and analysis on priority eye health domains and service access data

The desktop analysis was conducted over a one month period in May-June 2015. A search was conducted

to source data, and key stakeholders were contacted to provide advice on appropriate data sources (in

particular, the Victorian Koolin Balit Eye Health Advisory group). The process included:

Analysing demographic and population level health status data by local government area (LGA) in

the priority health domains of eye health, eye health behaviours and diabetes

Analysing available data on eye health determinants and most-at-risk populations: people over 40

years, smokers, people with diabetes and Aboriginal and Torres Strait Islander populations

(including the National Indigenous Eye Health Survey, 2009)

Using the Indigenous Eye Health Unit Eye Care Workforce Calculator to assess current optometry

consultations being delivered against required workforce calculations (discussed further on page

17 in the workforce needs analysis section)

Analysing service access and usage11 in rural, regional and remote communities, including Medicare

Benefits Schedule (MBS) data, and assessing distribution of optometry practice density by

geographic area.

Mapping current VOS service delivery models (including private providers and Australian College

of Optometry)

Mapping current RHOF and MOICDP service delivery data

Ranking and prioritising data to establish a heat map of service needs through a Gap analysis of

LGA locations by eye health need against current outreach optometry services (VOS, RHOF,

MOICDP) in order to establish priority service locations, taking into account the prioritisation of RA

locations.

11 Service usage data for VOS will not be available to inform the 2015-6 service plan.


2. Consultation with key and local informants to verify need and assess feasibility for service

Over an eight-week period in May–July 2015, RWAV consulted with a range of stakeholders using semi-

structured interviews (in person or by telephone), and via an online survey. The consultation plan was

designed to:

Validate the service needs identified through the data, identify existing health services to address

needs and service gaps, and support future health service planning

Establish or strengthen productive relationships with organisations with health service planning

responsibilities

Assess the current VOS outreach services according to community need

Establish whether the eye health service mix established under VOS, MOICDP and RHOF is

responding to the current health needs and trends.

RWAV identified four key stakeholder groups to consult:

1. Koolin Balit Aboriginal Eye Health Advisory Group is the primary statewide stakeholder body

representing all key eye health representatives (see Appendix A for the membership list). In the

absence of Medicare Locals and Primary Health Networks12, Victorian Government Department of

Health and Human Services (DHHS) regional offices were consulted regarding knowledge about

regional trends and service systems.

2. Australian College of Optometry is the primary institutional provider of VOS services in rural and

regional Victoria.

3. Local health services, including community health, district health, and Aboriginal Community

Controlled Health Services, who hold knowledge on local area health needs and gaps in the local

system.

4. Current VOS service providers were consulted on their existing outreach model and operational

knowledge to identify any remaining service gaps and improve the future administration of the

scheme.

Limitations of the data

This needs assessment is limited by the health and demographic data that is currently made available by

the Australian Government. This research draws on the best publicly available data, while acknowledging

its limitations and results should be considered an estimate of need.

Entry to the eye health system often begins with GPs, either in private practice or in a community health

service or ACCHO, and Aboriginal patient identification in primary care remains under-reported.13 The

relatively small Aboriginal and Torres Strait Islander population recorded in the 2011 Census means that

there is no publicly available specific health indicator data at Victorian LGA level. In regards to Aboriginal

12 Due to the timing of this project during the bridge period between the closure of Medicare Locals on 30 June 2015 and the

establishment of Primary Health Networks on 1 July 2015 13 Data on Aboriginal eye health in Victoria: what comes out is only as good as what goes in (2014)


and Torres Strait Islander people, this needs assessment therefore relies on the available national, state

and regional information and information gained from consultations.

About this report

This report presents the findings from the needs assessment conducted by Larter Consulting at the

request of RWAV to inform the administration of the VicOutreach Optometrists Scheme in Victoria from

July 2015. This needs assessment report contributes to a more comprehensive and open approach to

planning and developing services that will allow new VOS funding to be targeted at regions and

communities with the highest levels of need.

The report is arranged in the following sections: section two presents the key findings from the data

analysis and stakeholder consultations that underlie and shape RWAV’s recommendations for VOS service

delivery in Victoria discussed in section three. In turn, these inform the service delivery plan in section

four of the report.


2. Understanding optometry needs in rural and regional

Victoria

This section reports on the data analysis and key and local informants consultations in order to establish

service and location priorities for the delivery of outreach optometry in rural and regional Victoria. It

informs the recommendations for VOS service delivery in section 3 of this report.

What the data told us about need

A review of both state and national data on eye health and related healthcare utilisation revealed that the

data set is limited. Eye health data is not reported nationally through regular health performance

framework reports. The lack of current, comprehensive and reportable indicators on eye health and eye

care utilisation challenges service planning for eye health services. The following describes the data

sources that have informed the needs assessment and the selection of the prioritised services, attached to

this report.

The prevalence of eye problems in Australia is not known with any great certainty, and the first

nationwide study of the prevalence of eye conditions in Australians (the National Eye Health Survey) is

only currently underway.14 National health statistics published by AIHW often do not include specific

indicators for eye health.15 The eye health data available at Victorian LGA level is limited (and commenced

from 2010-11), but remains the most comprehensive indicators accessed for the purpose of this needs

assessment.

The National Aboriginal and Torres Strait Islander Health Performance Framework does not include any

specific indicators around eye health. While eye health is included in MBS health assessments, no statistics

for participation in eye health examinations are reported.16 The National Indigenous Eye Health Survey

was designed to provide essential baseline evidence to be used to plan and prioritise the effective

delivery of eye care for Indigenous Australians. While the survey assessed the prevalence and main causes

of vision impairment, as well as the utilisation of eye care services, barriers to health and the impact of

vision impairment, the results were not reported in detail by jurisdiction. While the results for Indigenous

children indicate better vision than the overall population, Indigenous adults experience blindness at a

rate six-fold higher. Four conditions cause 94% of the vision loss (refractive error, cataract, diabetes,

trachoma), and each is readily amenable to treatment. The unmet needs in eye health are similar for

Indigenous Australians in urban and regional areas as in remote areas.17

A report by Access Economics estimated that in 2009 there were almost 145,370 people aged 40 or over

with vision loss in Victoria, accounting for more than 5.9 per cent of the population in this age group. Of

14 Australian Institute of Health and Welfare, http://www.aihw.gov.au/eye-health-facts/; Conducted by Vision 2020 Australia and the

Centre for Eye Research Australia 15 A guide to Australian eye health data, 2e 2009. Australian Institute of Health and Welfare. Canberra. AIHW cat. no. PHE 86; Eye

health labour force, AIHW, 2009 16 Taylor HR, Anjou MD, Boudville AI, McNeil RJ. The Roadmap to Close the Gap for Vision: Full Report. Melbourne: Indigenous Eye

Health Unit, Melbourne School of Population Health, The University of Melbourne, ISBN 978073404756 4; 2012. 17 National Indigenous Eye Health Survey, 2009


these, around 16,940 people were blind.18 Approximately 60 per cent of this vision loss is related to

uncorrected refractive error, which can usually be corrected through glasses prescribed by an eye health

professional. The populations most at risk, for whom regular eye tests are most recommended, are:

1. People over the age of 40

2. smokers

3. people with diabetes

4. those with a family history of eye disease and

5. Aboriginal and Torres Strait Islander people.19

The Victorian excerpt of the 2011-12 ABS Australian Health Survey showed proportional increases in all

the following indicators (except smoking, which decreased marginally) since the last survey in 2007-08.

Figure 2: Selected eye health risk data from ABS Australian Health Survey

2007-08 survey 2011-12 survey

Total population 5,164,700 5,556,600

Long term conditions

Diabetes mellitus 196,800 210,700

Long sightedness 1,154,500 1,385,000

Short sightedness 1,189,500 1,337,400

Lifestyle factors

Current daily smoker 682,500 719,100

Victorian Population Health Survey 2011-12

The eye health component of the 2011-12 Victorian Population Health Survey20 assessed the following

four domains:

1. whether respondents had ever seen an eye specialist, and the timing of their last visit

2. whether they had been diagnosed with a specific eye condition

3. whether they had noticed a change in their vision in the last 12 months

4. whether they engaged in sun-protective behaviours (sunglasses and hat).

Accessing an eye professional was measured in three categories:

1. having never visited an eye professional

18 Access Economics 2010, Clear focus: the economic impact of vision loss in Australia in 2009. An overview of the report prepared

for Vision 2020 Australia by Access Economics Pty Limited, Access Economics, Melbourne. 19 Victorian Population Health Survey 2011-12, p407 20 Department of Health 2014. Victorian Population Health Survey 2011–12. State Government of Victoria, Melbourne


2. having visited an eye professional five years or more prior

3. having visited an eye professional less than six months prior.

Darebin, Greater Geelong, Greater Shepparton and Latrobe LGAs are identified as having a higher

proportion of people aged over 40, smokers, people with diabetes and people of Aboriginal and Torres

Strait Islander descent. A large number of people residing in these LGAs do not have regular eye tests,

putting them at increased risk of eye disease.

Some key findings relevant to the delivery of outreach optometry and other eye health services across

rural and regional Victoria include:

In the Campaspe, Mitchell and Queenscliff LGAs, significantly higher proportions of people had

never seen an eye health professional, compared with all Victorian adults.

Proportions of Victorians reporting visiting an eye professional in the last six months were

significantly lower in rural Victoria than metropolitan Melbourne.

There were no significant differences between metropolitan and rural areas in the proportion of

people who had noticed a change in their vision.

The survey found no significant differences in the prevalence of glaucoma, diabetic retinopathy or

macular degeneration between people who lived in the metropolitan area compared with rural

Victoria. The prevalence of macular degeneration was significantly higher in men and adults who

lived in Gippsland Region compared with all Victorian men and adults, respectively.

A higher proportion of people living in rural Victoria wore both a hat and sunglasses than those in

metropolitan locations.

The survey assessed relationships between these indicators of eye health and socio economic

status (SES) (measured by total annual household income), finding a relationship between change

in vision, sun-protective behaviours and people who had never seen an eye professional, and

declining SES.21

The key results from this population health data have been used to represent a heat map of priorities in

Figure 3, resulting in an overall priority grading in the final column (discussed further on page 29-30).

Figure 3: Heat map of select LGAs indicating risk, based on LGA eye health data and overall risk/priority

grading

RA

VOS

2011-

20141 LGA

Visited an eye professional ATSI

population

%(number)2 Diabetes3 Smoking

Proportion of

needed

optometry

consultations

delivered4

RISK/

PRIORITY

GRADING

Never

visited >5 years

Last 6

months

Barwon South West 7%

2/3 Moyne 1.24 (200) 2

2/3

Southern

Grampians MEDIUM 1.19 (196) HIGH 1

3 Glenelg 2.16 (428) 2

3 MEDIUM Corangamite 0.77 (128) 1

21 See the full Victorian Population Health Survey 2011-12 report for a more detailed discussion


RA

VOS

2011-

20141 LGA

Visited an eye professional ATSI

population

%(number)2 Diabetes3 Smoking

Proportion of

needed

optometry

consultations

delivered4

RISK/

PRIORITY

GRADING

Never

visited >5 years

Last 6

months

2 Queenscliff HIGH 0.49 (15) 3

2 Surf Coast HIGH HIGH 0.57 (152) 3

Grampians 16%

3 Northern Grampians HIGH 1.27 (152) 2

2 Ballarat 1.27 (1208) HIGH HIGH 3

3 Hindmarsh HIGH 1.55 (91) HIGH 2

4 Hindmarsh HIGH 1.55 (91) HIGH 1

3 Yarriambiack 1.55 (91) 3

3 West Wimmera 0.73 (31) HIGH 3

Loddon Mallee 50%

3 MEDIUM Mildura 3.79 (1966) HIGH 1

2 Campaspe HIGH 2.35 (861) HIGH 1

3 Swan Hill 4.57 (951) HIGH

3 Gannawarra HIGH

3 Loddon MEDIUM HIGH HIGH 1.48 (111) 1

3 Buloke 0.58 (37) HIGH 2

2

Greater

Bendigo HIGH 1.49 (1518) HIGH

2 Mt Alexander HIGH 1.04 (185) 3

2 Pyrenees HIGH HIGH 1.03 (70) HIGH HIGH 3

Hume 8%

3 Towong HIGH HIGH 1.48 (88) 1

2 Greater Shepparton HIGH 3.63 (2240) HIGH HIGH 1

2 Wodonga HIGH HIGH 3

2 Mitchell Shire HIGH 1.23 (432) 1

3 Mansfield MEDIUM HIGH HIGH 0.74 (59) HIGH HIGH 1

3 HIGH Alpine MEDIUM HIGH 0.73 (88) 1

2/3 Benalla MEDIUM HIGH 1.27 (174) 1

2 Moira MEDIUM HIGH 1.48 (421) HIGH 1

2 Strathbogie HIGH 0.97 (94) 3

2 or 3

Gippsland 33%

3 Wellington HIGH

3 East Gippsland HIGH HIGH 3.33 (1424) 1

4 HIGH East Gippsland HIGH HIGH 3.33 (1424) 1

2 La Trobe 1.53 (1124) HIGH

2 Sth Gippsland MEDIUM HIGH 0.78 (214) 1

1The Commonwealth VOS priorities for 2011-14 program 2 The 20 catchments with largest population numbers are marked for priority 3 Diabetes priority determined by high hospital; admissions &/or renal dialysis 4 Proportion of optometry consultations delivered against estimated needs, by region (discussed on page 18 on projected eye care

workforce needs)


Overall, this data substantiates the need for Victoria’s ageing population to have better access to eye

professionals in order to prevent avoidable sight loss. Regular eye tests are particularly important for the

at-risk groups. Addressing the gap between use of eye health professionals by Victoria’s rural population

and metropolitan areas seen in this data will contribute to this.

Analysis of optometry services in Australia

A market analysis of optometry services completed for the Commonwealth Department for Health in

201422 found that in Victoria, services are concentrated around Melbourne. East of a line connecting

Warrnambool, Ballarat, Bendigo and Echuca, optometry practices are located approximately in line with

population numbers. To the west of this line there are fewer optometry practices per million of

population, and in the north-west of the state, there are several postcodes without even one practice. A

map of the Victorian market is attached for reference in Appendix B. The key patterns of data have not

contributed directly to the service needs analysis, as the data can be misleading as the representation of

practice density per million people does not adequately reflect numerous access barrier issues, and as

such, can only contribute to an overall picture of service planning needs.

Medicare data

There are several Medicare items that can be charged for optometry. The largest number of these services

(838,155 in calendar year 2014) was provided for item 10900, a comprehensive eye examination, available

to all Medicare card holders, and usually bulk billed. More than one in eight comprehensive examinations

were for children (aged 14 and under, 103,016 (12%), and more than one in three for Victorians aged over

55 years (281,369 33.5% of this item).23 A summary of the comprehensive eye examination data is attached

in Appendix C. Of particular note is that Victoria’s per capita use of ‘comprehensive eye examination’

Medicare billing (14,159 services per 100,000 population) is below the national average (14,612 services

per 100,000 population), and behind NSW, Queensland, WA, SA, Tasmania and the ACT.

Optometry Australia and the Australian National University have recently compiled all the

epidemiological, demographic and eye care data sets available to provide an estimate of unmet need for

eye care across SA3 regions. Data was collated from the following sources to create the eye health heat

map: ABS National Health Survey (2011-12); Census of Australia (2011); Department of Health Visiting

Optometrist Scheme (2014); DHS Medicare Statistics (2013-14); Health Workforce Australia Health

Workforce (2012). A visual representation of The National Eye Health Heat Map for Victoria has been

included in Appendix D, and the eye care need score has been incorporated into the needs assessment as

another data source.

What the consultations told us about need

Local health service stakeholders were consulted to validate the service needs identified through the data

and to identify existing access to optometry services, including any VOS service plans. The engagement

also identified appropriate service delivery models and began identifying existing local networks to

22 ACIL Allen Consulting, Optometry Market Analysis, 2014 23 Optometry Australia


ensure outreach service planning is aligned and integrated with local needs assessments and service

plans. Current VOS service providers were also contacted, both private providers and the Australian

College of Optometry, to contribute to the assessment of needs.

Identifying important themes with key stakeholders

Following is a summary of RWAV’s consultations with key stakeholders and the key themes that emerged

and shaped the recommendations in this report as well as be prioritised for review during future VOS

service planning.

Australian College of Optometry

The Australian College of Optometry (ACO) is a not-for-profit organisation providing affordable eye care

and glasses in Victoria. The ACO services are provided in partnership with the Victorian Eye care Service

(VES) funded by DHHS and delivered in collaboration with a network of private practitioners in

metropolitan, regional and rural areas. The VOS and VicOutreach programs also support the ACO's

visiting services. To date, the ACO has informally negotiated arrangements with the ACCHO sector to

provide optometry services to Aboriginal and Torres Strait Islander clients throughout the state. Most of

these services are delivered through a visiting optometrist bus service that conducts clinics onsite at the

local ACCHO. The service delivery circuits of these visits are summarised further in the report in Figure 6.

The ACO also provided summary estimates of known patients waiting for optometry review (as at June

2015), including those with diabetes, which contributed to the service needs analysis.

Aboriginal Eye Health

Vision loss from diabetes, cataract and refractive error is common in Aboriginal communities in Victoria

yet 94% of vision loss in the Aboriginal community is preventable or treatable. A number of schemes and

eye care services currently support eye health in Aboriginal community members, including the VOS,

VicOutreach Aboriginal Health, and the Victorian Aboriginal Spectacle Subsidy Scheme (VASSS). The

VASSS is funded by DHHS as part of Koolin Balit, the Victorian Government strategic directions for

Aboriginal Health, and is supported by the VES. It is administered by the Australian College of Optometry

in partnership with Aboriginal Community Controlled Health Organisations (ACCHOs) and a network of

optometrists in regional Victoria.

A regional approach to eye care: Regional Aboriginal Eye Health Projects

The Roadmap to Close the Gap for Vision (2012) (the ‘Roadmap’) recommends a regional approach to

delivery, coordination and reporting on eye health24 and the service delivery models developed through

the Roadmap reflect this. In Victoria, the Roadmap implementation is being enhanced through one

statewide and four regional Indigenous eye health projects funded by Koolin Balit. These projects aim to

develop and strengthen regional networks and improve coordination and referral pathways. The project

officers are engaging local Aboriginal community controlled health services, optometry, ophthalmology,

and hospital services in the mapping of service gaps, determination of needs and developing local

24 Taylor HR, Anjou MD, Boudville AI, McNeil RJ. The Roadmap to Close the Gap for Vision: Full Report. Melbourne: Indigenous Eye

Health Unit, Melbourne School of Population Health, The University of Melbourne, ISBN 978073404756 4; 2012.


strategies to promote better outcomes for Indigenous eye health. The current coverage of eye health

projects in Victoria is included in Appendix E.

The Grampians Aboriginal Regional Eye Health project is the benchmark regional eye health project for

Australia. The project is trialling the process implementation required to improve Indigenous eye health

outcomes and involves calculating workforce needs, better integration of different parts of the eye health

system (ophthalmologists, optometrists, hospitals and primary care), and a case management approach to

servicing populations at risk. Consultations emphasised the importance of a local regional stakeholder

group of ophthalmologists, optometrists, hospitals and primary care coming together to coordinate care.

The IEHU workforce tool (see the following page) is used to calculate the consultations, spectacles, and

procedures required for the local communities at the three ACCHO sites. The clinical software is used to

find patients with diabetes for review (of health status and retinal exam) and follow up. Across the three

Aboriginal health services, the retinal screening rate of people with diabetes is now 75 per cent. Another

key outcome is a Professional Eye Health Services Directory for the Grampians region, listing optometry

practices, low vision clinics and ophthalmological services, by town, workforce FTE hours, and

participation in subsidy schemes (Victorian Aboriginal Spectacle Subsidy Scheme, bulk billing, Victorian

Eye Care Service). The next stage of the project will focus on educating both service providers and

community members to promote better eye health outcomes. This is particularly important as the ACCHO

patient lists only comprise approximately 60-70 per cent of the local Aboriginal population.

The VACCHO project supports at state level by conducting eye health training for Aboriginal Health

Workers; developing culturally appropriate resources and education materials; and implementing an

awareness campaign to community and service providers across the state about improving access to

quality spectacles and sight aids and to specialist treatments. The consultation emphasised the need for a

layered approach to working with ACCHOs around eye health needs, in the same vein as the case

management approach seeing success in the Grampians region. Quality onsite engagement about needs

and processes will result in more sustainable pathways, especially given the diversity of communities

across Victoria.

Local and jurisdictional coordination of eye care services

Consultations provided little evidence of local or regional management of eye care provision. Some

elements of the delivery of eye care are managed well by practitioners and providers (especially in the

approach by the new Indigenous eye health projects), but there is not a systemic approach to achieve

consistent, effective and targeted outcomes. There was no consistent appreciation at local level of the

population-based determination of needs. The approach was more site-based, determined by patient lists

rather than explicit need. Eye health coordination functions at regional government, Primary Health

Network or Primary Care Partnership-level do not exist, resulting in a fragmented statewide approach to

population based planning.

A workforce needs analysis for the delivery of eye care services

The Indigenous Eye Health Unit (IEHU) at the University of Melbourne has established an evidence base

and policy framework for Indigenous eye health in Australia. IEHU’s signature project, The Roadmap to


Close the Gap for Vision25, seeks to eliminate the known differences in the standard of eye health in

Indigenous Australians compared to the wider Australian population. The project has developed 42 policy

recommendations across nine domains of activity to support this goal. The Roadmap model, an

interlinked set of recommendations to improve access to and utilisation of comprehensive eye care, is

summarised below:

1. Provide eye health workforce to meet population needs

a. Population-based needs determine eye health workforce. Workforce needs analyses in all

regions, aiming for sufficient ophthalmology & optometry in all regions

2. Improve contracting & management of visiting services

a. VOS and RHOF work effectively & properly coordinated. Linkages between RHOF/MOICDP

& RHOF/VOS with ML/PHN & LHN. New fundholder arrangements for planning &

coordination

3. Appropriate resources for eye care in rural & remote areas

a. Services are adequate to meet eye care needs. Aiming for sufficient workforce & resources

in all regions, and needs analyses completed in all regions

4. Increase utilisation of services in urban areas

a. VOS supports AHS eye care in both regional & urban areas.

5. Billing for visiting MSOAP supported services

a. RHOF services are bulkbilled. Bulkbilling policy paper developed & endorsed.

6. Rural education & training of eye health workforce

IEHU has developed an evidence-informed model for eye health coordination, included in Appendix F, a

Regional Implementation Toolkit and a workforce calculator to deliver its models of service delivery

developed in The Roadmap to Close the Gap for Vision, integrating and coordinating the three levels of

eye care. The eye workforce calculator uses the following FTE workforce ratios to calculate the basic eye

care workforce needs per 10,000 population:

3.8 optometrists

1.3 ophthalmologists

31.5 coordinating function

IEHU is currently working on twelve regional assessments with state health departments and Medicare

Locals/Primary Health Networks to estimate regional workforce needs against what services are currently

provided using ten eye health indicators to measure and monitor health system performance and equity

25 Taylor HR, Anjou MD, Boudville AI, McNeil RJ. The Roadmap to Close the Gap for Vision: Full Report. Melbourne: Indigenous Eye

Health Unit, Melbourne School of Population Health, The University of Melbourne, ISBN 978073404756 4; 2012.


of access to eye care services. The Unit recommends that there should be greater regional responsibility

to monitor and account for outreach activity. The Australian College of Optometry is now employing this

projected workforce needs model to measure its service delivery regionally. Figure 4 highlights the

proportion of service currently being delivered, with four DHHS regions (figures bolded in table) - Hume,

Grampians, Barwon and Southern - showing particular gaps in needs being met.

Figure 4: Eye care projected needs by DHHS region, Victoria

DHHS regions Projected annual need for

eye examination

ACO optometry

consultations delivered 2014

Proportion

delivered

%

Gippsland 649 217 33

Loddon Mallee 985 490 50

Hume 776 63 8

Grampians 409 67 16

Barwon 600 44 7

Southern 940 151 16

North West 1544 607 39

Eastern 504 123 25

Verifying data, service plans and gap analysis

The data discussed so far was collated to create a service need heat map by LGA. The eye health service

needs were prioritised based on a collective analysis of the layers of data and an overall priority score (1-

3) was determined to represent a general estimate of the need for visiting optometry within each

catchment. Consulting with local community health providers, including ACCHOs where relevant, then

validated these service needs. If need was verified, appropriate service delivery models for the area were

also discussed.

Aboriginal Community Controlled Health Organisations

This needs assessment consulted with 22 Aboriginal community controlled health organisations

(Appendix G). The ACO currently delivers VOS and/or MOICDP services to 18 of these services, so the

consultations confirmed the current service models and identified if the few ACCHOs without VOS service

identified any gaps. The following section summarises the key themes that emerged from these

discussions.

Most informants expressed high satisfaction with current visiting optometry services provided by the

ACO, emphasising the management, coordination and integration of services. The ACO was commended

for its clear and specific requests for staff and other resources at each site, so that outreach appointments

and day schedules ran seamlessly. The ACO van is equipped to perform retinal scanning for diabetes and

is well integrated with local services and VASSS. The ACO is flexible and responsive to needs, with


informant reporting that the ACO will attend community Health Check days, and/or come earlier than

scheduled if patient lists are full.

The visiting optometrists service community members from kindergarten age through to elders, and

people living with diabetes. ACCHOs reported that VOS meets the needs of recalls and deteriorating eyes,

and health promotion activity. Many ACCHOs reported that the waiting lists were always full, and that if a

patient did not attend, within a large clinic there were other patients who could be called in to replace

them. The Healesville service cited the VOS program as more popular than other health outreach, both

because there was less stigma associated with eye health, but more importantly, because the entire

service could be delivered within the one familiar environment. However, in Lakes Entrance and

Warrnambool informants reported that clients have well established relationships with local private

optometry providers and do not rely on the ACCHO for optometry service.

The statewide eye health project officer emphasised that most individual ACCHO sites across the state

were yet to undergo the case management process which is being implemented through the regional

projects. Once this processes for identifying higher-risk patients is implemented, the non-project sites

may need to adjust their optometry consultation need calculations in the future. For example, Mildura,

Echuca, Wodonga, Lake Tyers, and Bairnsdale are all sites that confirmed that the frequency of current

VOS visits is meeting their needs, yet the data on patients waiting for an eye examination, and particularly

those with diabetes, are particularly high.

Some of the ACCHOs reported success in integrating the VOS service into overall health and as a tool for

timely diagnosis of other disease. Rumbalara in particular emphasised the importance of a fortnightly

service (rather than monthly) so that eye health could be more systematically established into patients'

routine visits with the diabetes educator and chronic disease nurses. Rumbalara recently lost access to its

VOS service when the local private provider has ceased delivering outreach. Issues of cultural sensitivity

with some private providers in Shepparton and a patient list during the last six months of 39 new

optometry referrals, 140 patients with diabetes and 82 patients with other chronic diseases means this

service is flagged for prioritisation.

Some of the issues identified through consultation include space limitations for visiting practitioners

when assessing the need for more optometry services, with informants reporting that some VOS services

sometimes have to be delivered out of administrative offices. At one site that does not currently receive

any VOS services, there appears to be some disagreement between the practice management team who

have identified local need for optometry services and the executive team. Another site, the Dhauwurd

Wurrung Elderly and Community Health Service in Portland, participates in a regional Healthy Eyes and

Ears consortium through Winda-Mara and does not want to jeopardise this program but expressed an

interest in discussing further the potential to receive VOS services in the future.

Community Health and District Health Services

Based on the analysis of data on eye health and service access in rural and regional Victoria, RWAV

consulted with 22 local health services in the catchments identified as high risk of priority need (Figure 5),

to verify need, assess access to services and begin to document infrastructure supports. The following

section summarises the key themes that emerged from these discussions.


Figure 5: Local service consultation to verify need priority catchments

LOCATION ACCHO Community health/district health service

Timboon Timboon & District Healthcare Service

Cobden Terang & Mortlake Health Service

Boort, Pyramid Hill East Wimmera Health Service, Northern District

Community Health Service, Boort District Health

Corryong Upper Murray Health & Community Services,

Tallangatta Health Service, Walwa Bush Nursing

Mooroopna Rumbalara Aboriginal Cooperative

[VOS recently cancelled]

Broadford, Kilmore Mitchell Community Health Service, Seymour Health

Mansfield Mansfield District Hospital

Benalla Benalla Health

Cobram Cobram District Hospital, Yarrawonga District Health

Service

Omeo Omeo District Health

Foster Australian College of Optometry

Minyip Dunmunkle Health Services

Edenhope Edenhope & District Hospital

Euroa Euroa Health

Hamilton Winda-Mara Aboriginal

Corporation/Barwon Eye Project

Western District Health Service, Casterton Memorial

Hospital

Rainbow West Wimmera Health Service

Echuca Njernda Aboriginal Corporation Echuca Regional Health

Ouyen Mallee Track Health & Community Services

Gelantipy West Wimmera Health Service

Alpine Alpine Health

Heywood Winda-Mara Aboriginal

Corporation/Barwon Eye Project

Framlingham Winda-Mara Aboriginal

Corporation/Barwon Eye

Project/Kirrae Health Service

Orbost Moogji Aboriginal Council Orbost Regional Health

Lake Tyers Lake Tyers Health & Children's

Services

Nowa Nowa Community Health

Jeparit West Wimmera Health Service


Demographic summaries

Despite being identified in Victorian population level health data as areas of priority need for eye health

and/or access to eye health services, few of the community health informants collected relevant concrete

data on eye health.

Informants at community and district health services identified the following populations in need of

outreach optometry services: ageing populations, residential aged care facility residents, people living

with diabetes and schools. ACCHOs prioritised people living with diabetes, health promotion days,

kindergarten children, middle-aged people and elders.

Many of the community health services in rural areas reported high risk factors in the population (an

ageing population, high levels of diabetes and chronic disease) and barriers to service access within their

catchments, but only some could provide data on these. Risk factors common to rural and remote areas

included small, and largely ageing, populations in large geographic catchments with small outlying towns

and few transport options. Access to specialists and/or outreach was limited in many cases. For example,

Edenhope in western Victoria is sparsely populated and has high need for most medical services, while

Euroa and Violet Town catchments have no community health service and rely completely on outreach

services.

In some cases, a low socioeconomic profile overlapping with high numbers of pensioners and people

living with disability mean that local community services find it difficult to monitor and support patients’

eye health under these circumstances, and the cost of spectacles is seen as prohibitive. The Loddon Mallee

region was highlighted as an example struggling with these risk factors and a recent marked increase in

diagnosis of diabetes. Seymour Health estimated that 30 per cent of their population is living with

diabetes.

Population ageing consistent with the rate for rural Victoria was report by many catchments (4.1% per

annum growth projected for the population aged 70 years and over). At some sites, the largest segment

of the population was nearing retirement (age group 55 to 64), whereas in others, most of the population

was over 65 years, with many in the 70 to 80 age group. Consequently, there was age-related increase in

the incidence of chronic disease reported at many sites. Reports of eye care service needs were consistent

with a rapidly ageing population. Lack of access to eye health services at residential aged care facilities

were reported by many rural health services. Where provided, metric data for these issues were

incorporated into the service needs analysis.

It was common for the catchments identified with priority needs in Figure 5 to have to travel 50

kilometres or more to access their closest private optometry service provider. This was identified as an

acute challenge for older populations who were unlikely to travel that distance and did not access service

providers as a result. However, the Avoca-Lexton-Beaufort catchment identified as high priority in the

population level data is a short distance to a large regional town so distance to services alone cannot

account for reduced access and requires further investigation of the data indicating risk.

Several locations reported well established local health networks and referral networks to regional centres

which would welcome and facilitate the integration of optometry outreach. Some of the sites do have

access to a range of allied health services, either locally or through outreach, including chronic disease

management, physiotherapy, occupational therapy, speech pathology, podiatry, dietetics, social work,

dental services, foot care, and health promotion. The majority of the sites listed in Figure 5 have access to


a diabetes support framework, comprising some combination of diabetes educators, dieticians, high risk

foot clinics and/or podiatrists, and prevention programs, within which optometry services would be well

integrated and supported. Some community health sites offered coordination and administrative support

for the VOS service. In remote areas such as Walwa on the New South Wales border, the small population

requires strict coordination by the local health service for any outreach service to function successfully but

it would be very well received.

Private optometry outreach

In three cases, community health informants reported a private optometry provider conducting outreach

in a private capacity at the local town. The lack of integration with local services (and lack of access to

data on eye health) and the vulnerability to variation if the provider chose to cease/reduce the service

were reported as challenges. In other cases, the private provider did not offer any subsidised schemes and

financially vulnerable patients could not afford to utilise the service and/or travelled to a discount

optometrist at a regional centre.

In the Alpine catchment, a private provider from Wangaratta visits Myrtleford and a VOS provider visits

Mt Beauty, but the catchment comprises two valleys, which are not easily traversed. Bright is an area of

likely eye health needs (high retired population, residential aged care facilities, community-based

services) but with transport challenges to outreach sites (45 kilometres). The Myrtleford Community

Health Service has just appointed a diabetes educator after a two-year vacancy. This position covers two

health clinic sites and home nursing, and is currently re-establishing service and networks to the

catchment. The catchment would benefit from service needs review in twelve months and is an example

of the ‘priority review’ indicator in the needs assessment.

Royal Flying Doctor Service (RFDS)

The West Wimmera Health Service (WWHS) in far west Victoria (Nhill) has identified a series of small

farming communities with an ageing population and many aged care residents but without access to

optometry service. Population sizes are small: Rainbow 525, Jeparit 632, Kaniva 1061, Natimuk 449,

Goroke 623, and all have a WWHS site with reception services and consulting suites. The ACO has

previously provided services to residents of aged care facilities in these locations in partnership with a

local optometrist, however VOS funding has not allowed for this delivery during the past 12 months. As of

July 2015, WWHS have negotiated with the Royal Flying Doctor Service (RFDS) to address these areas of

need through service to both the aged care facilities and outreach clinics in the community, with a

schedule yet to be determined. This area is prioritised for review in 12 months.26

3. Recommendations for VOS services in Victoria

Taking into account the needs verified through data analysis, RWAV analysed the gaps in the service

needs spreadsheet by priority indicator to develop recommendations for the delivery of future VOS

services in Victoria. The recommendations presented in this section consider:

26 All of the above community health sites except Goroke have acute and or residential services attached, The residential care beds

to benefit from outreach optometry are as follows: Rainbow 20, Jeparit 15, Nhill 26, Kaniva 21, Natimuk 41.


a. the gap in access to optometry services for rural and remote locations

b. the current impact of VOS delivery, and

c. the extent to which current gaps can be addressed with available VOS funding.

Unmet service needs in Victoria

The needs assessment first considered the current VOS circuits and locations, including the two services

cancelled in the second half of 2015 (Figure 6).

Figure 6: Existing VOS delivery circuits and locations in Victoria, including two cancelled services

VOS service location/circuit Optometry days per year Provider

Lake Tyers, Orbost, Lakes Entrance 14 ACO

Mildura, Dareton, Robinvale 16 ACO

Echuca, Swan Hill, Kerang 14 ACO

Wodonga 5 ACO

Wangoom, Hamilton 7.5 ACO

Bairnsdale, Sale, Morwell 9 ACO

Bendigo 6 ACO

Mallacoota 12 private

Orbost 24 private

Mooroopna 16 [CANCELLED] private

Mt Beauty 24 private

Corryong 28 [CANCELLED] private

St Arnaud 40 Private

Mt Gambier (South Australia) 12 ACO

The key layers of data on eye health and services in Victoria, the current VOS service delivery plan,

estimates against the workforce needs calculated by IEHU, and indicators of community verification. LGAs

were compiled and sorted by priority based on a collective analysis of data and consultation, with 46 rural

LGAs and 15 metropolitan sites prioritised by heat map determined according to the following

determinants:

Priority 1 Priority 2 Priority 3

RA4

Never seen an eye professional

LGA top 4 priority areas (based on age,

smoking, diabetes, size of Aboriginal

population, regular eye tests)

3+ indicators of high need

>50km away from optometry service

2011 VOS prioritisation

High need for regular eye tests (e.g.

priority score on 2 service access

categories), in RA3 or greater

Identified for priority by informant,

requires further investigation

High Aboriginal population, no service

RA3 and any

indicator of need

RA2 with 3 indicators

of need

All RA3 locations not

being serviced

These prioritised catchments (Figure 7, over the page) were further disaggregated into locations that:


1. should be considered for a new VOS service, and

2. those with existing services which the needs assessment indicates may require future review for

frequency.

During the process of seeking new services for a catchment, the opportunity to participate in the scheme

should be offered to local optometry providers as a mechanism of building capacity. Any centralised VOS

service can then augment and complement the local site-based delivery plan. A small number of private

providers were identified as part of this needs assessment exercise, who are either currently providing

outreach services in a private capacity or have expressed interest in doing so (see Appendix H).

The service delivery plan in the following section provides detail about the proposed new VOS locations

and circuits based on estimates of budget availability.

Figure 7: Priority locations, with no current outreach optometry service access, or with VOS services in

need of future review of frequency



Timboon 1 Hamilton 1

Cobden 1 Rainbow 1

Boort, Pyramid Hill, Mitiamo, Wedderburn 1 Omeo, Benambra 1

Corryong 1 Mildura 3

Mooroopna 1 Echuca 1

Broadford, Kilmore, Seymour 1 Swan Hill, Kerang 2, 3

Mansfield, Tolmie, Merrijig, Jamieson 1 Wodonga 3

Benalla, Glenrowan, Mollyullah 1 Bairnsdale 1

Cobram, Yarrawonga, Numurkah 1 Lake Tyers 2

Foster, Leongatha, Fish Creek 2 Ouyen 1

Euroa, Violet Town, Nagambie, Ruffy 3 Gelantipy 1

Minyip 3 Alpine 1

Edenhope 3 Heywood 2

Framlingham 2

Orbost 2

Lake Tyers 2

Jeparit 3

Efficiencies in outreach

The 2011 evaluation of the VOS recommended aligning optometry outreach with other outreach eye

health services. Anecdotally, a previous lack of coordination between the outreach services delivered


through VOS, MOICDP and RHOF has led to duplication (for example in eye exams, refraction

assessments). Adequate population level service planning in rural and regional Victoria is needed to

ensure the appropriate level of service, in the right region, in the right sequence, with the right frequency.

The RHOF, MOICDP and VOS outreach programs need to be better integrated but further analysis of their

governance structures is required to best shape this integration, which is beyond the scope of this needs

assessment. The Koolin Balit advisory group is well positioned to contribute to this process. Figure 8

summarises the current schedule across the three programs in Victoria.

Figure 8: Current eye health outreach visits per annum in rural and regional Victoria, by outreach program

LOCATION VOS MOICDP RHOF

Lake Tyers, Orbost, Lakes Entrance 4

Mildura 4 44

Echuca, Swan Hill 4 1 41 Echuca

11 Kerang

11 Swan Hill

Alexandra, Mansfield 22 Alexandra

11 Mansfield

Wodonga 4 1

Wangoom, Hamilton 4 10 Casterton

Bairnsdale, Sale, Morwell 4

Horsham region 2 22 Ararat

22 Stawell

18 Horsham

Nhill 11

Bendigo 8

Ballarat 10

Mallacoota 12

Orbost 24

Mooroopna 16

Mt Beauty 24

Corryong 28

St Arnaud 40


Case coordination and management

The use of optometry (and ophthalmology) services by Aboriginal and Torres Strait Islander clients is not

directly correlated with availability of services. Cultural safety, the need to be culturally recognised within

a health care system that reflects an individual’s culture, language, customs, attitudes and beliefs27, is a

significant factor in accessibility of health care. ACCHOs play an essential bridging role between local care

and the visiting services. Aboriginal health workers assist patients to navigate the hospital system and to

feel conformable staying in an unfamiliar, culturally unsafe, hospital environment, should patients require

further treatment. The IEHU reports successful eye care outcomes for patients with complex needs,

especially including those with diabetes, through care coordination. 28 Given that people with diabetes

require annual eye exams and 20-30% of these will need referral to ophthalmology for assessment for

laser and cataract surgery, care coordination is an essential role for chronic disease case managers. This

coordinating or case management role at ACCHOs for eye health needs to be further explored.

Ongoing fundholder management and coordination

The Roadmap report emphasises the need to include Aboriginal and Torres Strait Islander eye health in

the priority mandates of Primary Health Networks (PHN).29 The PHN scope extends to working closely

with ACCHOs, assessing local eye care capacity, leading the development of service directories and

referral protocols, assessing for additional VOS, MOICDP and RHOF services and coordination needs, and

employing Closing the Gap/Indigenous Chronic Disease coordinators.30 Given this report occurred at the

cusp of PHN establishment, this report recommends that this opportunity be explored in the coming year.

(Note, the National Eye Health Heat Map reports needs by PHN boundary.31)

The VOS evaluation reported significant underspend of the budget allocation, recommending that the

VOS service delivery would benefit from six-monthly reviews of service delivery. In future years of VOS

administration, as the different outreach services are better integrated, this review should consider

coordinating VOS services with the ophthalmology outreach services.

Funding agreements with VOS optometrists should stipulate that information about the visiting service

(the visits schedule, service location, appointment contact details) is publically available and shared for

planning and coordination purposes. The funding agreements should provide a requirement to update

this information when it changes.

Urban VOS services

The unmet needs in Aboriginal and Torres Strait Islander eye health are similar in urban and regional

areas as in remote areas, and the VOS evaluation found that VOS services could increase utilisation of

services in urban Aboriginal health services. RWAV’s consultations revealed that unmet needs for

Aboriginal and Torres Strait Islander people in Melbourne are in eye care coordination and service

27 Eckermann, A., Dowd, T., Martin, M., Dixon, L., Gray, R., & Chong, E., 1992, Binan Goonj: Bridging cultures in Aboriginal health,

Armidale, Department of Aboriginal and Multicultural Studies, University of New England. 28 Roadmap 29 Roadmap 30 Roadmap 31 http://graphcdev.aphcri.anu.edu.au/RMT_au/optometry/index.html


linkages rather than geographic access to optometry consultations. As funding has become available, the

ACO has been working to increase services to outer metropolitan areas to facilitate access (outlined in the

ACO service plan). This report recommends that urban locations for VOS services be earmarked for further

review in at least 12 months’ time, once the VOS and other services are established and integrated.

Figure 10 summarises the current optometry outreach activity in RA1 Melbourne and Geelong. The ‘other’

optometry days in Figure 10 refers to a service provided by ACO and VES that does not utilise VOS or

MOICDP funding.


Figure 10: Urban VOS delivery and service need

RA LGA Last eye test Census

pop. Diabetes

Workforce

needs

Annual optometry

days Never >5 yrs

DHHS Southern Metro 16%

1 Greater Dandenong MEDIUM 546 13 MOICDP

1 Cardinia MEDIUM 453

1 Casey MEDIUM 1502

1 Port Phillip 330 1 other

DHHS North Western Metro 39%

1 Darebin MEDIUM 1281 1 other

1 Whittlesea 1217 5 MOICDP

5 other

1 Moreland 785 1 MOICDP

DHHS Eastern Metro 25%

1 Yarra Ranges HIGH 1040 4 MOICDP

1 Yarra (VAHS) 366 98 other

1 Maroondah 439 2 other

1 Greater Geelong 1899 HIGH

1 Frankston 1088

1 Mornington Peninsula 1053 ACO identified

need

1 Melton 854 10 other

1 Brimbank 783

1 Hume 1153

1 Wyndham 1235 11 other

Final remarks

Several recommendations from the 2011 VOS evaluation have not been addressed in this report and

future VOS service planning will be mindful of:

Exploring opportunities to improve the effectiveness of outreach services: how eye health registers

might be utilised to ensure services are well targeted; how information can be better shared

between optometrists and ophthalmologists; how rates of ‘did not attend’ can be reduced; the role

optometrists can play in eye health awareness and education.

Exploring opportunities to aggregate data available through federal funding such as VOS and

MOICDP, state spectacle schemes, Medicare, and state hospital reporting has the potential to be

aggregated to serve the delivery of better eye care. Outreach eye services in Victoria can contribute

a concerted and coordinated effort to collect, collate and consolidate eye health data.

The opportunity to develop a set of national indicators (for example, relating to cataract surgery,

timely diabetic retinal examinations, regular eye examinations for refractive error)


Future service planning will be supported by an increase in optometry graduates in Victoria resulting from

the new optometry school at Deakin which will likely contribute to increased availability of practitioners

and may support additional coverage to rural areas and care to disadvantaged groups.

Documents

Needs Assessment and Activity Plan for the VicOutreach ...€¦ · Contents Contents ... Verifying data, service plans and gap analysis ..... 21 3. Recommendations for VOS services