Every decision point for an optometrist is an opportunity to affect change that will drive a better patient outcome.
Therefore, it is crucial that the data from every patient journey is unpacked end-to-end, in order to provide an understanding of the significant decision points for an optometrist and reduce the likelihood of inconsistent or non-evidence-based decisions occurring at these junctures.
Identifying patients with diabetes
Unlike glaucoma, detection of diabetic retinopathy is most meaningfully measured relative to the diabetic population rather than the total patient population.
Furthermore, the reported estimation that 50% of people living with diabetes do not have their eyes routinely tested presents a challenge to the collection of eye health data for this group.
Identification of these patients as a subset of the total patient population was recognised as being key to measuring the impact of any initiative directed at their eye health outcomes. As such, in late 2018, updates were made to Specsavers’ patient management system to allow all optometrists to consistently identify patients with diabetes in a way that could be extracted easily within the data and impacted positively on ease and accuracy of clinical record keeping. This immediately provided unprecedented visibility of care provided to this patient group by optometrists.
This included the types of assessments performed for these patients (as per Medicare itemisation) and the proportion of patients for whom a collaborative care arrangement is in place.
It has also allowed for identification of the proportion of these patients who are being referred for ophthalmological assessment and management of diabetic retinopathy and/ or macula oedema – a metric that can now be understood in the context of currently reported prevalence.
Information regarding classification of severity of diabetic retinopathy allows for a greater understanding of the larger scale impact on patients and the overall health care system.
Reminders
In 2019, the Department of Health and Diabetes Australia reported on the grave concerns held for health outcomes for people with diabetes, including the proposed level of undiagnosed diabetic retinopathy and the financial burden this was projected to have on publicly and privately funded healthcare.
The launch of KeepSight, Australia’s first national diabetic eyecare reminder program, has been a momentous step forward, exemplifying alignment of Government, key patient support groups and Optometry in enhancing awareness and activating proven strategies to effectively ensure patients attend to see an optometrist and the care they receive is of a high standard.
Measurement of the impact of this initiative on eye health outcomes for patients with diabetes, rests upon the small but hugely significant changes detailed above.
As with glaucoma, the growing dataset continues to be analysed and is revealing the impact of systematic use of OCT on detection of sight-threatening aspects of the condition like macula oedema.
