TY - JOUR
T1 - The appropriateness of and barriers to glaucoma care delivery by Australian optometrists
AU - Toomey, Melinda
AU - Ho, Kam Chun
AU - Gyawali, Rajendra
AU - Stapleton, Fiona
AU - Wiles, Louise
AU - Hibbert, Peter
AU - Keay, Lisa
AU - Jalbert, Isabelle
N1 - Funding Information:
Melinda Toomey is supported through an Australian Government Research Training Program Scholarship and a University of New South Wales (UNSW) Scientia PhD Scholarship. Rajendra Gyawali is supported through a UNSW Scientia PhD Scholarship.
Publisher Copyright:
© 2022 Optometry Australia.
PY - 2022/8
Y1 - 2022/8
N2 - CLINICAL RELEVANCE: Establishing the level of appropriateness and barriers to glaucoma care delivery by Australian optometrists are important first steps in developing tailored interventions aimed at improving glaucoma care delivery.BACKGROUND: To determine the appropriateness of and barriers to glaucoma care by optometrists.METHODS: A mixed method study was conducted. Phase I was a retrospective cross-sectional medical record audit that assessed glaucoma care appropriateness against 37 clinical indicators from a nationally representative sample of 42 optometry practices. In Phase II, focus groups and interviews involving 31 optometrists explored audit findings to identify barriers to appropriate glaucoma care. Barriers were analysed by deductive and inductive qualitative analysis. Saliency analysis was used to identify key domains that influence glaucoma care.RESULTS: Appropriate glaucoma care was delivered for 63% (95% CI 61%, 64%) of the 420 patient encounters audited. Appropriate care was delivered above 80% for most (57%) indicators, while 14 (38%) indicators were delivered below 60% appropriateness. Good compliance to appropriate care was noted for key indicators of intraocular pressure measurement (90%, 95% CI 87%, 93%) and optic nerve head/retinal nerve fibre layer imaging (78%, 95% CI 74%, 82%). Important barriers identified were beliefs about expected outcomes, lack of perceived relevancy, time constraints, poor organisational culture, knowledge gaps, focusing on some aspects of glaucoma care to the detriment of others, the complexity of glaucoma care, information recall, and social norms.CONCLUSION: Glaucoma care was appropriate in most patient encounters, with opportunity to improve some aspects of history taking and physical examinations. Barriers to glaucoma care were diverse, existing at both the practitioner and organisational levels. These findings provide direction for the development of a tailored improvement intervention.
AB - CLINICAL RELEVANCE: Establishing the level of appropriateness and barriers to glaucoma care delivery by Australian optometrists are important first steps in developing tailored interventions aimed at improving glaucoma care delivery.BACKGROUND: To determine the appropriateness of and barriers to glaucoma care by optometrists.METHODS: A mixed method study was conducted. Phase I was a retrospective cross-sectional medical record audit that assessed glaucoma care appropriateness against 37 clinical indicators from a nationally representative sample of 42 optometry practices. In Phase II, focus groups and interviews involving 31 optometrists explored audit findings to identify barriers to appropriate glaucoma care. Barriers were analysed by deductive and inductive qualitative analysis. Saliency analysis was used to identify key domains that influence glaucoma care.RESULTS: Appropriate glaucoma care was delivered for 63% (95% CI 61%, 64%) of the 420 patient encounters audited. Appropriate care was delivered above 80% for most (57%) indicators, while 14 (38%) indicators were delivered below 60% appropriateness. Good compliance to appropriate care was noted for key indicators of intraocular pressure measurement (90%, 95% CI 87%, 93%) and optic nerve head/retinal nerve fibre layer imaging (78%, 95% CI 74%, 82%). Important barriers identified were beliefs about expected outcomes, lack of perceived relevancy, time constraints, poor organisational culture, knowledge gaps, focusing on some aspects of glaucoma care to the detriment of others, the complexity of glaucoma care, information recall, and social norms.CONCLUSION: Glaucoma care was appropriate in most patient encounters, with opportunity to improve some aspects of history taking and physical examinations. Barriers to glaucoma care were diverse, existing at both the practitioner and organisational levels. These findings provide direction for the development of a tailored improvement intervention.
KW - Australia
KW - Glaucoma/diagnosis
KW - Humans
KW - Optometrists
KW - Optometry/methods
KW - Retrospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85122867239&partnerID=8YFLogxK
U2 - 10.1080/08164622.2021.2004861
DO - 10.1080/08164622.2021.2004861
M3 - Article
C2 - 35037600
AN - SCOPUS:85122867239
SN - 0816-4622
VL - 105
SP - 593
EP - 601
JO - Clinical and Experimental Optometry
JF - Clinical and Experimental Optometry
IS - 6
ER -