Clinical indicators for assessment of optometric diabetic eyecare in Australia

Abstract

Purpose : Clinical indicators for diabetic eyecare were previously developed from clinical guidelines published before 2013 and were tested in a nationwide patient record card audit (iCareTrack study), to assess the appropriateness of optometric diabetic eyecare delivery in Australia. To reflect emerging evidence, updated guidelines, and contemporary optometry practice, this study aimed to update the diabetic eyecare clinical indicators.

Methods : Candidate indicators included existing iCareTrack and new indicators derived from nine high-quality evidence-based guidelines identified through a systematic review. A two-round modified Delphi process with an expert panel (eight optometrists and one ophthalmologist) was used for consensus on the candidate indicators. In round-1, the experts rated the impact, acceptability, and feasibility of the indicators on a 9-point scale and voted for inclusion or exclusion. Consensus on inclusion was defined when the median scores for impact, acceptability, and feasibility were ≥7 and >75% of experts voted for inclusion. Any indicator that failed to reach consensus was presented for re-evaluation in round-2, with updated evidence summaries, de-identified group feedback and any modification suggestions from round-1.

Results : Of the 45 candidate indicators presented in the Delphi process, 33 were retained in the final list. The final indicators were grouped in the domains of history taking (13), examination (8), recall (5), referral (6), and patient education (1). All 13 iCareTrack indicators were retained either in the original format or with minor modifications. New history taking indicators included documenting the type of diabetes, serum lipid level, pregnancy status, systemic medications, renal disease, Indigenous status, non-English speaking background, and details of patient’s general practitioner. Examination of pupil, intraocular pressure, optical coherence tomography, and diabetic retinopathy grading were added. Recall period for high-risk group without retinopathy, communication with general practitioner, referral of high-risk proliferative retinopathy, and patient education on regular follow up were also added.

Conclusions : The study described a systematic process of updating clinical indicators. These updated indicators will be the basis for a self-audit tool and allow assessment of diabetic eyecare appropriateness in Australia.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Clinical indicators for diabetic eyecare assessment