Coordination of Aboriginal Eye Health Activity (NSW …...coordination discussions Of 50 Aboriginal...

Supporting rural health in New South Wales, Australia

Coordination of Aboriginal Eye Health Activity (NSW and ACT)

Aboriginal Eye Health Coordination Project

Objective: ‘to improve access to eye care for Indigenous patients through improved coordination of services, including improved linkages between the range of services required by patients and enhanced delivery of those services’

KPIs for this Activity:

• Establishment of partnerships

• Identification of barriers and gaps to access to eye care services for Aboriginal patients in NSW and the ACT

• Implementation of new solutions

PresenterPresentation NotesIntroducing the AEHC program and KPIs – next section will be structured according to the KPIs

With data, predominantly looking at:Access to spectacles (as most of the ‘gap’ is caused by uncorrected refractive error)Access to cataract procedures (Aboriginal patients access at a considerably lower rate than non-Aboriginal patients in NSW)Access to treatment for DR (not included in this presentation as few hospitals report this in admitted patient data).

Establishment of Partnerships

• State Advisory Group – Aboriginal Eye Health – Membership includes:

• AH&MRC and Winnunga Nimmityjah • Optometry NSW • RANZCO • NSW/ACT PHN Aboriginal Health Network • Ministry of Health – Centre for Aboriginal Health • Key eye stakeholders – Brien Holden Vision, Outback Eye Service,

Vision Australia (NSW Spectacle Program) and VOS optometrists • 15 Regional Groups in NSW and the ACT

– Membership includes: • Aboriginal Health Services • Local Health Districts • Primary Health Networks

– Generally boundaries align with LHDs (not always)

PresenterPresentation Notes

Note: gap identified through the state group – currently Justice Health system is not included in analysis.

Patients in Justice Health are not eligible for Medicare (so will not be counted in MBS data or eligible for VOS supported services) and also required special (approved) glasses through NSW Spectacle Program. There is access to optometry (VisionCare NSW still provides optometry clinics in some locations). Access to ophthalmology is only through Long Bay (longstanding arrangement with the team at POW).

How does RDN identify and prioritise needs

Locally identified needs – supported by

evidence

Access to existing services

– to avoid duplication

Population, demographic,

socio-economic, geographic and health burden

data – to prioritise

resources

Financially sensible

Available workforce

coordination

Outreach compliments other workforce strategies by focusing on gaps and responding with health services where and when needed

PresenterPresentation NotesEye care barriers and enablers:Access to primary eye care in Aboriginal Health Service where possible – or alternative arrangements that suit local needsAccess to optometry is bulk billedAccess to NSW Spectacle Program, and low cost option for patients who are not eligibleClear referral pathway to specialist eye care servicesAccess to bulk billed ophthalmology services

With data, predominantly looking at:Access to spectacles (as most of the ‘gap’ is caused by uncorrected refractive error)Access to cataract procedures (Aboriginal patients access at a considerably lower rate than non-Aboriginal patients in NSW)Access to treatment for DR (not included in this presentation as few hospitals report this in admitted patient data).

Priority Themes from Regional Discussions

Does the AHS have clear access to bulk billed specialist services?

What do we know about access to optometry for Aboriginal patients in NSW and the ACT?

PresenterPresentation NotesOf 50 Aboriginal Health Services identified with some relevance to primary care, VOS (bulk billed) for 45 AHS (90%)Private arrangements (bulk billed) for 7 (4%)Unsure (unsure) for 3 (6%)

All VOS services provide access to the NSW Spectacle Program for eligible clients.

NSW Spectacle Scheme Claims in 2015-16

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Total Aboriginal Patient Claims Non-Aboriginal PatientClaims

VOS OptometristsResident Optometrists

NSW Spectacle Scheme Data provided by NSW Department of Family and Community Services

PresenterPresentation NotesAccess to the NSW Spectacle Program is an important measure of access – if it is not provided by local optometrists this is considered to be a gap in access.

NSW Spectacle Program Claims 2015-16 Total Claims 17496 Total non-Aboriginal Claims - VOS Optometrists 408 Total non-Aboriginal Claims - Local Optometrists 11938 Total Aboriginal Claims - Local Optometrists 723 Total Aboriginal Claims - VOS Optometrists 4427

Question for consideration:How could this group advocate for improved access to primary eye care services (particilarly spectacles) through the NSW Spectacle Program?

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Optometry Ophthalmology

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pro

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Type of service accessed

Unsure

Private (not funded through VOS, RHOF,MOICDP)

Outreach (incl. VOS, RHOF, MOICDP)

How do Aboriginal Health Services access eye care services?

Data collated by RDN through VOS and regional eye health coordination discussions

PresenterPresentation NotesOf 50 Aboriginal Health Services identified with some relevance to primary care, VOS (bulk billed) for 45 AHS (90%)Private arrangements (bulk billed) for 7 (4%)Unsure (unsure) for 3 (6%)

Note: I would like to also look at those who have arrangements with local optometrists as well – there are many informal arrangements that supplement access to VOS services.

Aboriginal Health Services in NSW – Access to bulk billing ophthalmology consultations

0

500

1000

1500

2000

2500

Metropolitan Rural Z New South Wales Total

Estimated number of cataracts required forAboriginal Patients for population in 2015/16(IEH)Number of cataracts completed on public listsfor Aboriginal patients in 2015/16

Access to public cataract surgery compared to population based estimate of need

20%

34% 29%

Population-based estimates using ABS 2015 estimated population and Indigenous Eye Health Unit service calculator. Data on cataract separations provided by NSW Ministry of Health.

In terms of total numbers, Rural LHDs are closer to meeting the population-based

need than Metropolitan counterparts

PresenterPresentation NotesNote: HNE LHD is considered rural, so this may

Equity of access to public cataract surgery

Non Aboriginal patients are almost

twice as likely to access public

cataract surgery in rural LHDs than

Aboriginal patients

Data on cataract separations provided by NSW Ministry of Health.

Chart1

1.79

2.92

2.61

5.26

Aboriginal Patients

1.79

2.92

MetropolitanRural1.7912296949194322.9232739040544771Non-Aboriginal Patients

2.61

5.26

MetropolitanRural2.6086200440756775.2596011842468631

Average number of public cataract procedures completed per 1,000 population from 2011-2016

Sheet2

Row LabelsAboriginal PatientsNon-Aboriginal Patients

Metropolitan1.792.61

Rural2.925.26

Grand Total2.323.85

1.79

2.92

2.61

5.26

Aboriginal Patients

1.79

2.92

MetropolitanRural1.7912296949194322.9232739040544771Non-Aboriginal Patients

2.61

5.26

MetropolitanRural2.6086200440756775.2596011842468631

Average number of public cataract procedures completed per 1,000 population from 2011-2016

Sheet1

Rates of cataract procedure per 1000 population - Indigenous and non-Indigenous

IndigenousNon-IndigenousPopulations (avg from ABS 2011 and ABS 2015 pop estimates)

Local Health District2011/122012/132013/142014/152015/16Average Aboriginal Rate2011/122012/132013/142014/152015/16Average non-Aboriginal RateIndigenousNon-IndigenousClassificationDifference Indigenous - Non-IndigenousOdds

Central Coast LHD1.131.602.263.114.152.4555566510601312083Metropolitan-3.000.4497675372

Far West LHD4.060.870.291.163.481.97655565344727656Rural-3.390.3681364264

Hunter New England LHD3.033.253.053.323.653.2644445444879825163Rural-1.130.7428846274

Illawarra Shoalhaven LHD2.613.273.432.943.023.0555555512247371761Metropolitan-2.010.602721981

Mid North Coast LHD2.313.683.853.344.883.61788710811686195443Rural-4.320.4553391486

Murrumbidgee LHD1.902.762.471.902.092.2233333310518223420Rural-0.800.7363782722

Nepean Blue Mountains LHD1.051.150.860.291.911.0521222210446340349Metropolitan-0.520.6704064564

Northern NSW LHD2.283.243.244.423.023.2468786713587279233Rural-3.600.4738342347

Northern Sydney LHD0.000.352.120.000.710.641111112826854057Metropolitan-0.230.7331338953

South Eastern Sydney LHD3.816.455.716.456.305.744444446826760259Metropolitan1.991.5298815935

South Western Sydney LHD1.000.400.471.070.800.7522222214947873753Metropolitan-1.140.39631693

Southern NSW LHD3.361.991.683.973.822.964445546545189574Rural-1.530.6599897746

Sydney LHD0.310.460.460.920.310.492222226511658901Metropolitan-1.640.2308153984

Western NSW LHD2.084.162.672.844.203.1955555528843244013Rural-1.600.6659170871

Western Sydney LHD0.070.000.000.070.600.1500000013341854574Metropolitan0.011.1025166553

Total2.122.662.392.633.092.5833333319725070102390.8583743121

*note: can't calculate rate per 1000 popfor St Vincent's Health Network or Sydney Children's because we don't know their geographic population. This means that the urban rates of surgery per population are not 100% accurate - need to consider how we do this.

Avg Indigenous Population for the period

198531

Avg Non-Indigenous Population for the period.

7058762.5

Total Lens Separations

IndigenousNon-Indigenous

2011/122012/132013/142014/152015/162011/122012/132013/142014/152015/16

Central Coast LHD12172433441,6171,5881,6971,7401,867

Far West LHD1431412161134136148162

Hunter New England LHD1361461371491643,6583,3973,5793,5813,902

Illawarra Shoalhaven LHD32404236371,9852,0281,7511,7421,912

Mid North Coast LHD27434539571,2861,5731,5731,4511,867

Murrumbidgee LHD2029262022614682694674711

Nepean Blue Mountains LHD11129320552472535581533

Northern NSW LHD31444460411,7832,1261,9402,1561,537

Northern Sydney LHD162747737743801682

South Eastern Sydney LHD26443944432,9443,0602,7822,8162,667

South Western Sydney LHD156716121,4731,4491,5641,7901,984

Southern NSW LHD2213112625725818812932970

St Vincent's Health Network2220203170176145

Sydney Children's Hospitals Network7417477607867

Sydney LHD233621,3501,4611,4161,4411,347

Western NSW LHD6012077821211,1311,1691,1121,1651,267

Western Sydney LHD11870877268284

Total41852547251961020,39021,06120,63621,34021,904

Indigenous Average Aboriginal RateCentral Coast LHDFar West LHDHunter New England LHDIllawarra Shoalhaven LHDMid North Coast LHDMurrumbidgee LHDNepean Blue Mountains LHDNorthern NSW LHDNorthern Sydney LHDSouth Eastern Sydney LHDSouth Western Sydney LHDSouthern NSW LHDSydney LHDWestern NSW LHDWestern Sydney LHD2.45259881143288411.97272991006672463.26210477060540563.05380909610516853.61115865137771672.22475755847119231.05303465441317263.23838963715316110.636942675159235755.74274831526516310.749314243660935242.96409472880061120.491475963753647723.18968207190652860.14991379956524997Non-Indigenous Average non-Aboriginal RateCentral Coast LHDFar West LHDHunter New England LHDIllawarra Shoalhaven LHDMid North Coast LHDMurrumbidgee LHDNepean Blue Mountains LHDNorthern NSW LHDNorthern Sydney LHDSouth Eastern Sydney LHDSouth Western Sydney LHDSouthern NSW LHDSydney LHDWestern NSW LHDWestern Sydney LHD5.45303653194823215.35869250795487514.39113241868576235.06669607624253177.93070102280460273.02121564765911771.57074062212611186.83443575795124490.868794471563373313.75372077147393181.8906945097756464.49112220030172972.12930318818760344.78990873437070960.13597418128798675

Average number of cataracts per 1,000 population from 2011-2016

PivotChart by LHD

Local Health DistrictSouth Western Sydney LHDRate of access to cataract procedures for Aboriginal and non-Aboriginal patients from July 2011 to June 2016 in South Western Sydney LHDRate of access to cataract procedures for Aboriginal and non-Aboriginal patients from July 2011 to June 2016 in

Row LabelsAboriginal patientsNon-Aboriginal patients

2011/1212

2012/130.42

2013/140.472

2014/151.072

2015/160.82

Grand Total3.7410

Rate of access to cataract procedures for Aboriginal and non-Aboriginal patients from July 2011 to June 2016 in South Western Sydney LHDAboriginal patients2011/122012/132013/142014/152015/1610.40.471.070.8Non-Aboriginal patients2011/122012/132013/142014/152015/1622222

Year

Rate of catarct procedures per 1,000 population

Access difference

ClassificationMetropolitan

Sum of Difference in rate of access per 1,000 popColumn Labels

Row LabelsCentral Coast LHDIllawarra Shoalhaven LHDNepean Blue Mountains LHDNorthern Sydney LHDSouth Eastern Sydney LHDSouth Western Sydney LHDSydney LHDWestern Sydney LHDGrand Total

2011/12-4.0493452631-2.39-0.95-1-0.19-1-1.690.7-10.5693452631

2012/13-3.4847676478-1.730.15-0.652.45-1.6-1.540-6.4047676478

2013/14-3.1737186438-1.57-1.141.121.71-1.53-1.540-6.1237186438

2014/15-2.4625259909-2.06-1.71-12.45-0.93-1.080.7-6.0925259909

2015/16-1.831831057-1.98-0.09-0.292.3-1.2-1.690.6-4.181831057

Grand Total-15.0021886026-9.73-3.74-1.828.72-6.26-7.542-33.3721886026

Difference in rate of access to cataract surgery per 1,000 population for Aboriginal and Non-Aboriginal patients in metropolitan local health districts from July 2011 to June 2016

Central Coast LHD2011/122012/132013/142014/152015/16-4.0493452631288545-3.4847676477629661-3.1737186437777267-2.4625259909090396-1.8318310569981522Illawarra Shoalhaven LHD2011/122012/132013/142014/152015/16-2.39-1.73-1.5699999999999998-2.06-1.98Nepean Blue Mountains LHD2011/122012/132013/142014/152015/16-0.950.14999999999999991-1.1400000000000001-1.71-9.000000000000008E-2Northern Sydney LHD2011/122012/132013/142014/152015/16-1-0.651.1200000000000001-1-0.29000000000000004South Eastern Sydney LHD2011/122012/132013/142014/152015/16-0.189999999999999952.45000000000000021.712.45000000000000022.2999999999999998South Western Sydney LHD2011/122012/132013/142014/152015/16-1-1.6-1.53-0.92999999999999994-1.2Sydney LHD2011/122012/132013/142014/152015/16-1.69-1.54-1.54-1.08-1.69Western Sydney LHD2011/122012/132013/142014/152015/160.7000.70.6

Year

Rate of cataracts per 1,000 Aboriginal patients seen - rate of cataracts per 1,000 non-Aboriginal patients seen

5 year trends

ClassificationLocal Health DistrictYearIndigenous rate per 1000 populationNon-Indigenous rate per 1000 populationDifference in rate of access per 1,000 pop

MetropolitanCentral Coast LHD2011/121.13196868225.1813139453-4.0493452631





RuralFar West LHD2011/120.87032201914.8452415389-3.9749195198




RuralFar West LHD2015/161.97272991010.33232932431.6404005857

RuralHunter New England LHD2011/123.034-1.4026929761





MetropolitanIllawarra Shoalhaven LHD2011/122.615-2.39





RuralMid North Coast LHD2011/122.317-4.69





RuralMurrumbidgee LHD2011/121.903-1.1





MetropolitanNepean Blue Mountains LHD2011/121.052-0.95

MetropolitanNepean Blue Mountains LHD2012/131.1510.15




RuralNorthern NSW LHD2011/122.286-3.72





MetropolitanNorthern Sydney LHD2011/120.001-1

MetropolitanNorthern Sydney LHD2012/130.351-0.65

MetropolitanNorthern Sydney LHD2013/142.1211.12

MetropolitanNorthern Sydney LHD2014/150.001-1

MetropolitanNorthern Sydney LHD2015/160.711-0.29

MetropolitanSouth Eastern Sydney LHD2011/123.814-0.19

MetropolitanSouth Eastern Sydney LHD2012/136.4542.45




MetropolitanSouth Western Sydney LHD2011/121.002-1

MetropolitanSouth Western Sydney LHD2012/130.402-1.6




RuralSouthern NSW LHD2011/123.364-0.64





MetropolitanSydney LHD2011/120.312-1.69





RuralWestern NSW LHD2011/122.085-2.92





MetropolitanWestern Sydney LHD2011/120.7000.7

MetropolitanWestern Sydney LHD2012/130.0000

MetropolitanWestern Sydney LHD2013/140.0000



Equity of access to public cataract surgery

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South Eastern Sydney is the only LHD where more

Aboriginal patients per 1,000 population

access than Non-Aboriginal patients

Mid North Coast LHD has the

most significant difference between

Aboriginal and non-Aboriginal

access

Estimated need

NSW Avg for Aboriginal Patients

NSW Avg for non-Aboriginal Patients

Data on cataract separations provided by NSW Ministry of Health.

New Solutions

Courtesy of Bulgarr Ngaru, Vincent Ang and Kylie Wyndham Tabulam VOS clinic

PresenterPresentation NotesNew VOS Services Implemented in 2016/17:Grafton, Coffs Harbour (Mid North Coast)Box Ridge, Coraki, Muli Muli, Tabulam (with complex diabetes clinics) (North Coast)Miller (South West Sydney)Singleton (Hunter)Narrabundah (ACT)

New needs identified for 17/18

VOS: Bowral, Maitland, Goulburn, Cooma, Ballina, Orient Point, Hornsby, St Leonards. MOICDP: Griffith (ophthalmology), Wyong (ophthalmology)

Cataract surgery expansionsHunter New England LHD: Armidale, Inverell, Tamworth, Moree (120 patients)Mid North Coast LHD: Macksville (84 patients)Murrumbidgee LHD: Wagga Wagga (112 patients)Southern NSW LHD: Goulburn (84 patients)400 patients in totalAboriginal patients on wait list have been prioritised for surgery in Mid North Coast and MurrumbidgeeAll planned before 30 June 2017

Summary

2016-17: Eye health coordination activity has been in establishment phase of building partnerships and collecting consistent data that can be used to inform discussions across the state

– By 30 June 2017, on track to have 14 of 15 planned partnerships established

– AIHW Indigenous eye health data report will help fill in any remaining gaps in data that is not already available locally

2017-18: Focus will be on interpreting the data in regional partnerships – Regions will have consistent state-wide set of data to help inform discussions

– New solutions expected to be implemented as a more nuanced understanding of barriers and enablers to access to services are identified

Slide Number 1Aboriginal Eye Health Coordination ProjectEstablishment of Partnerships How does RDN identify and prioritise needsPriority Themes from Regional DiscussionsWhat do we know about access to optometry for Aboriginal patients in NSW and the ACT?NSW Spectacle Scheme Claims in 2015-16How do Aboriginal Health Services access eye care services?Aboriginal Health Services in NSW – Access to bulk billing ophthalmology consultationsAccess to public cataract surgery compared to population based estimate of needEquity of access to public cataract surgeryEquity of access to public cataract surgeryNew Solutions�Summary

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