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Melinda Toomey, Kam Chun Ho, Rajendra Gyawali, Fiona Stapleton, Lisa Keay, Isabelle Jalbert; Appropriateness of and barriers to Glaucoma Care by Australian Optometrists. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3068.
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© ARVO (1962-2015); The Authors (2016-present)
Opportunity exists to improve glaucoma detection as 50% of Australians with glaucoma are undiagnosed, and of those, 50% had visited an ophthalmologist or optometrist in the prior 12 months. We performed a mixed method study (retrospective cross-sectional record audit and prospective focus group discussions (FGD) and interviews) to identify appropriateness of and barriers to glaucoma care delivery.
Patient records obtained from 42 randomly selected Australian optometry practices were audited against 35 glaucoma care clinical indicators derived from evidence-based clinical practice guidelines and reviewed via Delphi Consensus process by experts. Appropriateness was defined as care delivered in line with the indicators. FGD and interviews were conducted with optometrists to explore audit findings and identify barriers to appropriate glaucoma care. Barriers were coded to the Theoretical Domains Framework (TDF) to identify key themes which were in turn mapped to the Behaviour Change Wheel (BCW) to identify behaviour change techniques (BCT) to improve care.
Glaucoma care was delivered appropriately for 63% (95% CI 61-64%) of 420 practitioner-patient interactions audited. Appropriateness levels varied from high to moderate across glaucoma care domains: Referral 100% (95% CI 52-100%), Recall 92% (95% CI 71-100%), Physical Examination 64% (95% CI 62-66%), and History Taking 60% (95% CI 57-63%). Optometrists from a broad cross-section of practice modalities participated in the FGD (n=15) and interviews (n=3). Key barrier themes identified were environmental issues (time constraints, equipment availability, competing priorities), knowledge gaps, motivation, and impact of disease complexity on decision-making processes. Candidate BCT identified from mapping barrier themes to BCW were: Education (improving knowledge), Enablement (providing behavioural support) and Environmental restructuring (changing physical and social context).
Glaucoma care by Australian optometrists is appropriate in most practitioner-patient interactions but an opportunity exists to enhance the care domains of History Taking and Physical Examination, with the view to improve glaucoma detection. The next stage of this research will involve the design, implementation and evaluation of a multi-faceted intervention based on the BCT identified in this study to improve appropriate glaucoma care by Australian optometrists.
This is a 2020 ARVO Annual Meeting abstract.
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