Key Area for Action 5: Improving the evidence base

Sydney Local Health District

• 
  Why people with young onset type 2 diabetes (e.g. age < 30 years) have more diabetic retinopathy? Hitherto, research on diabetic retinopathy has focussed on type 1 diabetes. However, type 2 diabetes in young people has dramatically increased in prevalence, partly due to obesity, but also due to the Australian multi-cultural population. We conducted a systematic study and found that young people with type 2 diabetes actually have more complications, including retinopathy. This had a profound influence on our philosophy of treating type 2 diabetes, the emerging major health care problem of our community.
  

• 
  How can the prevalence of diabetic retinopathy be used as a surrogate for the standard of diabetes care in Australia? As we have a large diabetes database collected over 2-3 decades, we were able to use the information to evaluate secular trend and severity of diabetic retinopathy in our community. We found that the prevalence of retinopathy differs in population groups of different characteristics (e.g. Indigenous vs other ethnicities, socioeconomic status, language barrier). Our analysis led to the conclusion that the prevalence of retinopathy in a population can be used as a surrogate measurement of adequacy of diabetes care. This technique promises to be a pivotal step in assessing the provision of health care and evaluation of health economics.
  

• 
  The impact of new technology on the detection and treatment of diabetic retinopathy. Hitherto, screening of retinopathy is limited to examination of a small area of the retinae visible to direct observation or photography. In collaboration with an ophthalmologist in our area, we have used the new technique of ultra wide field photography to improve the sensitivity of retinopathy detection. This revealed many cases of vision threatening retinopathy which would otherwise be undetected. This procedure could influence greatly the screening process for this serious complication of diabetes in the wider community and also its optimal treatment.
  

Action Area: Eye Research Workforce Development

Illawarra Shoalhaven Local Health District (ISLHD)

Hunter New England Local Health District

Manilla HealthOne

The Optometrist at Manilla HealthOne contributed to the Diabetic Eye Health sub-committee of the ACI Ophthalmology Network. His rural experience provided rural context to the work of this group, developing clinical pathways for diabetic retinal screening and management.

Action Area: Eye Health Data

Sydney Local Health District

The Diabetes Centre, Royal Prince Alfred (RPA) Hospital implemented a system of universal screening for the presence of diabetic retinopathy using one of the following methods:

1. 
   retinal photography;
   
2. 
   direct fundoscopy; and
   
3. 
   reviewing and recording eye data obtained from either an outside optometrist or ophthalmologist.
   

This information constitutes a rarely available computerised database which allows the secular trend on prevalence and severity of retinopathy in the community to be analysed.

South East Sydney Local Health District/ Prince of Wales Hospital (SES LHD/POWH)

Support for service efficiency review of attendance data, visit frequency, monitoring systems performance, including activity based management systems.

Jurisdictional update – Northern Territory

Key Area for Action 1: Reducing the risk

Action Area: Raising Public Awareness

During the reporting period, increasing public awareness of eye disease, focusing on trachoma was undertaken in remote Aboriginal and Torres Strait communities through multiple strategies, including:

• 
  TV and radio advertising;
  
• 
  development and delivery of tailored, culturally appropriate health promotion resources;
  
• 
  clinical screening and treatment for trachoma infection;
  
• 
  collaboration with Melbourne Football Club in the NT to raise trachoma awareness; and
  
• 
  engagement with relevant stakeholders regarding healthy environments to promote clean faces (trachoma prevention).
  

The Healthy Under 5 Kids Program (HU5K) and school age screening also provided opportunities for raising awareness.
Between 2011-2014, specialist optometry, eye health team, nutritionist, diabetic educator and preventable chronic condition educator visits to remote communities provided opportunistic and planned eye health education and information.
The Commonwealth of Australia provided dedicated trachoma funding to the Northern Territory. This funding was directed towards clinical activities.

Challenges encountered during the reporting period:

• 
  recruitment and retention of Preventable Chronic Condition Educators and nursing staff as well as the limited access to an endocrinologist,
  
• 
  eye health teams and Optometrists due to the often irregular visiting service model for many remote locations.
  

Action Area: Maternal and Child Health

Between 2011-2014, educating children in schools and mothers with babies on hygiene and the importance of keeping faces and eyes clean was ongoing through preventive health checks. The HU5K Program provided a standardised approach for the provision of routine child health care to children under five living in remote communities of NT. The schedule of contacts in HU5K covers key areas of anticipatory guidance (age appropriate education and support), social and emotional health, child growth and nutrition, child development and timely identification and management of common treatable health problems, including eye disease.
This approach also facilitates targeting of limited resources to children who would benefit most, with observation of eye health, by health professionals (Aboriginal Health Worker (AHW)/Remote Area Nurse/Child Family Health Nurse (CFHN), undertaken at scheduled key stages as identified in HU5K. These scheduled visits occur when the child is: 10 days old, 4 weeks, 8 weeks, 4 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years and 4 years of age. Child health observations include eye screening, providing opportunity for anticipatory guidance to be provided to caregivers.

Vision screening is built into the development milestones tool used in the programme – Ages & Stages Questionnaires®, Third Edition (ASQ-3™). The ASQ-3 captures parents’ in-depth knowledge; highlights a child’s strengths as well as concerns; teaches parents about child development and their own child’s skills and highlights results that fall in a “monitoring zone,” to make it easier to keep track of children at risk.
Annual ‘Healthy School Aged Kids’ health checks were conducted in remote Indigenous communities which incorporated trachoma screening. ‘Clean faces’ message (trachoma prevention) was incorporated into Families as First Teachers Program and preschool programmes in the NT.

Challenges encountered during the reporting period:

• 
  recruitment and retention of child health nurses;
  
• 
  high staff turnover in remote NT Department of Health (DoH) clinics was a challenge for HU5K;
  
• 
  competing claims on the time of busy remote NT DoH staff; and
  
• 
  differing health programme age-related screening targets means concurrent screening is not always viable.
  
• 
  Limited reach of preschool and Families as First Teachers Program.
  

Action Area: People with Diabetes

Between 2011-2014, NT DoH provided a range of targeted eye care services that addressed the needs of diabetic clients. These services extended across a wide scope ranging from:

• 
  primary (community delivered) eye health services delivered by optometrists, ophthalmologists and vision care coordinators;
  
• 
  up-skilling and education activities with community based providers / carers; and
  
• 
  managed pathways into tertiary and interventional services within regional hospital facilities.
  

Challenges encountered during the reporting period included:

• 
  Client compliance with medications and participating in Patient Assistance Travel Scheme (PATS) for appointments; due to a high mobile population in remote communities
  

Action Area: Eye Injury Prevention

Between 2011-2014, opportunistic health education messages were provided to workers in remote locations regarding the need to use eye protection and sun protection for eyes. General eye health advice was provided to all mothers within the HU5K Program.

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