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Lack of funding for non-clinical support revealed in Indigenous eye health review

A new Indigenous eye health study has recommended greater financial backing for non-clinical support providers, a critical factor that has been linked to improved patient appointment attendance.

Published in the Medical Journal of Australia last week, the review also found that while non‐clinical support services are vital for ensuring access to preventive, primary and tertiary eyecare for Aboriginal and Torres Strait Islanders, the capacity to provide such services is currently limited.

The authors of the work titled: Non‐clinical eye care support for Aboriginal and Torres Strait Islander Australians: a systematic review, analysed data from 27 publications. They identified five key areas of non-clinical support for Indigenous eye health, including coordination of eyecare, integrating and linking services, cultural support, health promotion, and social and emotional support.

Lead author Dr Aryati Yashadhana, from the University of New South Wales (UNSW), said clinical services are central to improving preventive measures and reducing disease prevalence, but non-clinical support services can improve access and uptake of care.

The study recommended greater financial investment for key providers of non‐clinical support, especially eye health coordinators, community‐based liaison officers, and family members and carers. They can play a role in reducing anxiety about new diagnoses, interpret biomedical information, and enable cultural safety for Indigenous eyecare patients.

The authors noted the limited availability of personnel to fulfil the linguistic and cultural needs of Indigenous patients had resulted in burnout among a declining number of Aboriginal Health Workers who act as both family or community members and clinicians.

“We found that the availability of non-clinical support is associated with increased patient attendance at eyecare services, higher visual acuity examination and cataract surgery rates, broader eye health knowledge, and greater cultural responsivity,” Yashadhana told UNSW Media.

“Another key finding was the prominent role of eye health coordinators in providing these types of non-clinical support. However, eye health coordinators are often employed part-time, which may be attributable to the complex funding arrangements for eye health coordination.”

According to the researchers, the review highlighted a disconnect between acknowledging the important roles of family and community members in supporting the access to health care, and providing the specific resources and programs essential for supporting these roles.

For comparison, the researchers looked at a study of the engagement of Canadian indigenous people (Cree) with tele‐ophthalmology clinics.

The study described initiatives for overcoming linguistic and cultural barriers, including employing nurses fluent in Cree, incorporating cultural artefacts into clinic screening protocols, and introducing a cultural space (tepee), whereby Cree Elders played a key role in health promotion initiatives. The program increased the tele‐ophthalmology clinic attendance rate from 20% to 50% in the first and to 85% in the second year of its operation.

Funding conundrum

Professor Hugh Taylor, founder of the Indigenous Eye Health Unit at the University of Melbourne, said expansion of non-clinical support services is crucial if Australia is to meet its 2020 deadline to close the eye health disparity between Indigenous Australians and the broader population.

It will also be vital in order to meet a 2025 target to eliminate avoidable blindness within the Indigenous population.

For some Indigenous patients, he said the health system can be difficult to navigate, confronting and culturally challenging. Many required assistance to ensure they attended their eyecare appointments, however current funding levels for these support services are inadequate.

“One of the most egregious cases involved a patient who needed to travel from northern South Australia to Adelaide for eye surgery. He sat at a bus station for a day and half because he didn’t know where to go next and then took the bus home again,” Taylor said.

“There are all sorts of issues, the patient journey is full of difficult issues. Navigating this can be a challenge, particularly if you’re not totally comfortable in institutions or English is not your first language.”

Taylor said the issue could be drastically improved overnight if the government committed extra funding for the Integrated Team Care program, which would increase case management capacity.

“The last time I checked the government provided funding to support about 20,000 people with chronic disease, but our estimates show there are probably 70,000 people with diabetes who will all need some case management. They all need an eye exam each year, and someone needs to help them get that, so that program needs to be expanded dramatically to meet the need.

“The government supports the view, but they haven’t followed that up with funding, and that’s what we need.”