Paediatric Optometry Alignment Project: towards interprofessionalilty between paediatric eye care providers

Abstract

The Paediatric Optometry Alignment Project (POAP) was established in response to unsustainable demand for paediatric ophthalmology services in Queensland. In June 2015, 1700 children waited for an ophthalmology appointment at the Lady Cilento Children’s Hospital (LCCH), many longer than clinically recommended. Multiple factors contributed to this, including large numbers of children with stable, treated conditions returning for monitoring. It was apparent that collaboration with community optometrists reviewing these patients would improve access. However, a long history of mistrust exists between ophthalmology and optometry, creating a barrier to implementation. Change implemented : LCCH held a workshop on evidence-based paediatric eye care for community optometrists. Optometrists paid to attend the course, consisting of lectures and case discussions. They received referral guidelines, templates and access to online education. Following the workshop, optometrists could become ‘aligned’ with LCCH. Alignment was conditional upon having current registration/insurance, agreeing to follow clinical pathways, and having no affiliation with the Australasian College of Behavioural Optometry (ACBO). Communication channels were established to facilitate discussion and re-referral if necessary. The department began discharging to these optometrists in May 2016. Aim : To develop a shared model of outpatient care for children with specific chronic eye conditions; to manage tertiary hospital demand, improve access to specialist care and improve interprofessionality between ophthalmologists and optometrists. Targeted population/stakeholders : Children over 8yrs with stable, treated strabismus and amblyopia. Stakeholders include: patients/ families, community optometrists, Optometry Australia, Optometry Queensland Northern Territory, Royal Australian and New Zealand College of Ophthalmologists, Children’s Health Queensland and Queensland Department of Health. Timeline : • September 2015 – funding received • October 2015 - project officer recruited • March 2016 – workshop held • May 2016 – 42 optometrists aligned • May 2016 - discharge commenced • June 2016 - interim evaluation Highlights : First Australian project demonstrating collaboration between paediatric ophthalmologists and community optometrists. First international project demonstrating shared management of children with strabismus and amblyopia. Sustainability : Low ongoing costs: • optometrists pay to attend course; bill under Medicare • project officer cost offset by fewer travel subsidies for patients attending LCCH • future workshops planned in regional centres Transferability : The range of conditions discharged should expand over time as ophthalmologists’ trust in the model grows. Training of community providers to align with specialist management has been based on the success of antenatal shared-care programs. The model can be replicated in other specialties. Conclusions : POAP addressed a gap in optometry education, improved family-centredness of care, enhanced access to services and improved collaborative working arrangements between ophthalmologists and optometrists. Lessons learned : We failed to address the potential reputational and clinical risks involved in aligning with behavioural optometrists – a subset of ‘conventional optometrists’ before commencement of the project. Following legal advice, stricter inclusion and exclusion criteria were developed. Discussions : Formal evaluation will occur 12 months post-implementation, including clinical outcomes, wait list analysis and family and clinician satisfaction surveys. Final evaluation should demonstrate cost-effective, family-centred care for children with stable eye disease has been delivered, with excellent clinical outcomes and high family and clinician satisfaction.