Lisa's cover image
Lisa

Lisa Penrose-Herbert

Year of Award: 2016 Award State: Queensland Health And Medicine > Indigenous
The Dr Dorothea Sandars and Irene Lee Churchill Fellowship to explore models of integrated primary health care to improve Indigenous eye health - USA, Canada
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Major Lessons 

  • Australia has collected data on the eye health status of Indigenous Australians, and the size of the gap in vision. There is little eye health specific data available in Canada and the USA, for the Indigenous populations. 
  • Community engagement is integral to success of visiting eye services, and it is important that any visiting programs transition to community ownership over time. 
  • Comprehensive, effective eye health services require a team-based approach where PHC staff, optometrists, ophthalmologists and any other eye health professionals are all working together in a co-ordinated program where each person’s skill and role is understood, respected and included in overall patient management. 
  • Integration of health care into overall community well-being programs can provide valuable learnings from diverse programs, from housing, to employment services, to education. 
  • Diabetic retinopathy screening can be very effective when integrated into overall diabetic health care, as part of a diabetic health screening program. It also can reduce costs of running the diabetic retinopathy screening program. 
  • Opinions differ significantly as to the importance of pupil dilation in retinal image acquisition between different diabetic retinopathy screening programs utilising retinal photography. 
  • All diabetic retinopathy screening programs visited utilised either wide field retinal images or multiple field retinal photography. 
  • Utilising multiple eye images also allows the incorporation of image acquisition protocols such as the inclusion of external eye images, and patient identification images. These protocols can improve cataract detection and minimise errors in assigning images and reports to the correct patient electronic medical record file. 
  • Wide field retinal imaging utilising 3D imaging is effective in triaging many types of retinal eye health conditions, including diabetic retinopathy. 
  • It is easier to train image acquisition staff in wide field retinal photography than multiple narrow field photography. 
  • Wide field retinal photos have a significantly lower rate of “ungradable” images than multiple single field photos. 
  • Centralised grading centres for retinal image reading provide advantages in retaining and recruiting skilled readers. 
  • Centralised grading centres for retinal image reading provide advantages for brainstorming and collaborative opinions on clinical triaging. 
  • Centralised grading centres for retinal image reading provide advantages in continual quality improvement for image acquisition staff- allowing feedback, troubleshooting, and quality control measures. 
  • Image acquisition training provided centrally can provide “on the job” training alongside a skilled image taker, along with a standardised face to face training program. 
  • Image acquisition training provided centrally can provide regular training program availability to train new staff due to staff turnover or new site development. It can also ensure imagers requiring retraining can have access to standardised, regular, training program availability. 
  • Retinal cameras and other equipment are best purchased from a minimum of 2 different supply channels, to ensure against a supplier ceasing trading, spare parts becoming unavailable, and warranty issues.
  • Maintenance and cleaning of equipment including retinal cameras should be a very important element of any training program. 
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