Coordination of outreach eye services in remote Australia.

BACKGROUND This paper aims to describe models for service integration between ophthalmology and optometry when conducting outreach eye services. The effect of good coordination on clinical activity and cost-effectiveness is examined. DESIGN Cross-sectional case study based on remote outreach ophthalmology services in Australia. PARTICIPANTS Key stake-holders from eye services in nine outreach regions participated in the study. METHODS Semistructured interviews were conducted to perform a qualitative assessment of outreach eye services' levels of coordination. Records of clinical activity were used to statistically compare the effects of good coordination. MAIN OUTCOME MEASURES Clinical activity (surgery and clinic consultation rates), waiting times and costs per attendance. Surgical case rate being the proportion of surgery that results from a clinic. RESULTS Service integration between optometry and ophthalmology resulted in an increased surgical case rate for ophthalmology clinics (R(2) = 0.57). There were trends towards increased clinical activity and reduced waiting times, and costs/attendance were stable. CONCLUSIONS Coordination of eye services with better integration of ophthalmology and optometry roles may improve efficiency of services for patients. Coordination of eye services has multiple facets including facilitating engagement with the local community, eye professions and health facilities. The varied roles of eye health coordination require further definition and appropriate funding.