Associate Professor Angus Turner (second from right) with Albany optometrists involved in tele-health (L-R) Nisha Jeyaseelan, Alistair Bruce, Alison Steer, Martin Anderson and Andrew Taylor
By Helen Carter
A new MBS tele-health item for optometrists will give rural patients more timely assessment and access to eye treatment including surgery, Perth ophthalmologist Angus Turner says.
The Australian Government intends to add the new item, announced in the Federal Budget, to the MBS on 1 September.
The item will reimburse optometrists for their time and use of their equipment involved in tele-health consultations.
Associate Professor Angus Turner is based at the Lions Eye Institute and is director of Lions Outback Vision, which aims to deliver specialist eye health care services to regional, remote and Indigenous communities across Western Australia.
In 2011, Medicare tele-health rebates were introduced for GPs referring to specialists.
‘After trying to establish a tele-health system for outreach services in Western Australia, we realised that optometrists were best placed to perform tele-health referrals,’ Professor Turner said.
‘A one-year pilot trial funded by the Ophthalmic Research Institute of Australia, a research fund of the Royal Australian and New Zealand College of Ophthalmologists, provided a system for optometrists to do tele-health and be appropriately remunerated.
‘This intervention was designed to increase use of the Lions Outback Vision tele-health service by optometrists in five regional Western Australian towns.’
An audit in 2012 before the intervention was compared with an audit in 2014 after remuneration to optometrists, logistical support, an easy to use referral pathway and awareness raising were introduced.
After the intervention, use of the tele-health service increased more than three-fold, rising from optometrists conducting 60 consultations in 2012 to 211 consultations in 2014.
More referrals in 2014 were non-urgent cases such as cataract and glaucoma (69 per cent) than in 2012 (32 per cent). Consultations for non-urgent cases enabled treatment to start sooner for glaucoma or cataract surgery.
‘It worked very well and augmented our outreach services, provided better continuity of care and reduced the burden on outpatient clinics as many patients were directly streamlined for surgical procedures,’ Professor Turner said.
‘Giving optometrists “rebatable” access to tele-health makes it more accessible for patients because tele-health clinics are available daily, unlike intermittent outreach clinics, enabling quicker assessment and more timely access.’
In the trial, half the optometrists were present at tele-health consultations with the patient and ophthalmologist. The other half did not attend but provided support beforehand to facilitate video conferencing by preparing examination reports, and emailing test results and images to the specialist.
The trial helped demonstrate a case for sustainable tele-health. This, coupled with a business case and medico-legal considerations, were prepared by Lions Outback Vision for the government. Both Optometry Australia and RANZCO supported the measure.
Optometrist Stephen Copeland conducts tele-health consultations with Indigenous patients in remote areas, linking to Associate Professor Angus Turner in Perth
For Lions Eye Institute optometrist Stephen Copeland, tele-health has helped make the referral process more efficient.
‘It has helped identify cases that could be managed medically in the community rather than requiring patient transfer. I have also seen how tele-health has eased the trepidation of patients who consented to go ahead with cataract surgery only after the video-consultation,’ he said.
The MBS item was also welcomed by the Fred Hollows Foundation, which partners with the Lions Eye Institute in delivering specialist outreach eye-care services in the remote regions of WA and uses tele-health to provide quality and timely eye care to patients living in these areas.
‘The foundation welcomes this initiative which will benefit many Aboriginal and Torres Strait Islander people living in remote and underserviced communities who often wait many months to see an ophthalmologist in person,’ the manager of the Fred Hollows Foundation’s Indigenous Australia Program, Jaki Barton, said.
Optometry Western Australia CEO Tony Martella said that Western Australia was a vast state with unique circumstances and conditions that made eye health services not only difficult to deliver but at times extremely trying.
‘It’s great to see that optometry can now access a Medicare tele-health rebate. Optometry continues to be at the forefront of community health through its committed delivery of quality eye health services,’ Mr Martella said.
‘It’s also wonderful to see the continually closer links that are being embraced between optometry and ophthalmology in the delivery of these services here in Western Australia.
‘I congratulate Dr Angus Turner and his team for the successful result in obtaining the Medicare rebate. I know Optometry Australia was pleased to have the opportunity to work with Angus in advocating for these new items.
‘We look forward to continuing to work together and providing the best level of care possible for those patients in need in remote areas.’