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Working toward a common vision

04/06/2018
Australians are living longer than ever before, and while this is something to celebrate, it’s also a problem.

The average life expectancy in Australia has risen to 82.8 years – a decade higher than the rest of the world’s population. With an ageing population there is an associated increase in the prevalence of chronic eye conditions, such as age-related macular degeneration, glaucoma and diabetic retinopathy, which increases the strain on healthcare resources.

Already in Australia, the median waiting period for a routine, non-urgent, public hospital ophthalmology assessment is in excess of three months.

In addition to our ageing population, there has been a concurrent shift toward ever higher standards of care. Patients are now “healthcare consumers” and should form the centre of care, which means our education and training programs, practice models and information dissemination need to be “reconfigured” accordingly.

"It is about maximising the eyecare of our patients through better information sharing, expertise and infrastructure among all related healthcare professionals and their patients"

Technological innovations, including ocular imaging, have also revolutionised eyecare and shifted the focus toward earlier detection. The latter highly sensitive devices enable the detection of more cases with greater precision; however, cases of disease that are detected earlier also need longer and more regular follow up.

Thus, the growing burden of disease is quickly evolving into a burden of care.

However, within this era of disruption resides an opportunity. The optometric profession in Australia is 5,521 members strong and holds a privileged position within the healthcare system. As primary carers in relation to eye disease, we are the gatekeepers.

We all hold a vested interest in providing the best possible care for our patients. We are mandated to provide an accurate diagnosis and to translate that diagnosis into a practical management plan.

It goes without saying that over-diagnosis, low- or no-value practices and unproven interventions should be avoided, while cost-effective and personalised management options encouraged. However, treatment or care beyond the level of expertise that we as individuals can offer is also often required.

As such, we have a professional obligation to provide a continuity of care, and to aid our patients in navigating what’s often described as a fragmented and complex health care system.

There is an undeniable difference in the training, skills and expertise between optometry versus other eyecare professions. However, given the current availability of diagnostic tools and resources, and the evolving scope of practice, optometrists should be constantly striving to ensure they have exemplary clinical skills.

On an individual, intra-professional level, there is also variation in the level of care that we offer. In some cases, this variation may be welcome but other times it may not.

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Differing thresholds for recommending contact lens wear is unlikely to be harmful; on the other hand, a difference in judgment regarding an iris melanoma may have dire consequences.

But, while there is a cornucopia of new information constantly being released, there is only so much time to up-skill. Enter the untapped potential and growing interest worldwide in collective intelligence, collaborative and integrated care models.

Collective intelligence refers to shared or group cognition, behaviour and decision-making that emerges from collaborative, collective efforts and competition of individuals. It is about maximising the eyecare of our patients through better information sharing, expertise and infrastructure among all related healthcare professionals and their patients.

We can begin by talking and listening more to each other about how we practice (over-coffee, online or between consults), the cases we excelled in managing and the cases we didn’t. If you bulk-bill, when was the last time you billed a 10905 or enabled a colleague to? Medicare statistics from the 2016-2017 financial year suggest that these consultations form just 0.1% of total claims.

Greater utilisation of inter-optometric referral pathways would represent a step forward. Stronger, more explicit and frequent communication between us and other members of the multi-disciplinary care team also has potentially exponential benefits.

For the benefit of our patients, these intra-professional communications could extend, for example, from general practitioners to orientation and mobility instructors.

There are patients slipping through the cracks; 50% and 25% of patients with glaucoma and AMD, respectively are undiagnosed. Strategies such as these will allow us to play a more active role in demanding that our patients see the right professional at the right time for the right level of care. Ultimately, we are working toward a common vision.

What does the collective intelligence look like to you?


Name: Angelica Ly
Qualification: BOptom (Hons), GradCertOcTher, FAAO, PhD candidate
Organisation: Centre for Eye Health, UNSW Sydney
Position: Integrated Care Co-ordinator, Principal Staff Optometrist
Location: Sydney, NSW
Years in the profession: 9

 

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