Table-Top Presentation Abstracts

1. Updating the model of eye care for Aboriginal populations in remote Central Australia

Dr William Mitchell, Dr Mark Hassall, Dr Tim Henderson (Alice Springs Hospital, Central Australian Health Service)

Objectives: In central Australia, the number of full-time ophthalmologists per-capita is 19-times lower than the national average. Eye disease is the third-largest contributor toward the health-inequality gap for Aboriginal Australians, and despite the 6-fold greater prevalence of blindness, they’re 10-times less likely to receive surgery.

This paper studies how the central Australian ophthalmology service addresses remote eye-care complexities, and how to update current services to meet future needs.

Methods: MEDLINE and governmental reports were analysed collaboratively with specialists from central Australia and the Australian Department of Health.

Results: Central Australian eye-care can be understood at 3 levels. At the healthcare service level, Aboriginal primary-care services manage common eye diseases, and bridge to either optometry; crucial in reducing refractive error; or ophthalmology; which has doubled outreach services since 2000. At the community level, eye “champions” and mutual community support is crucial in motivating reluctant, fearful patients toward healthcare engagement. Sadly, Australia remains the only developed country with blinding endemic trachoma, despite regimented screening and >50% reduction since 2006. At the healthcare system level, whilst crucial initiatives rely on private-funding, government-funded models have enabled sustainable service expansion; with more needed to address anticipated disease-burden growth.

Conclusions: Eye disease remains an enormous public health issue. Understanding effective central Australian models will help direct ongoing efforts to reduce persisting disparity for Aboriginal Australians.

2. Early Detection of Diabetic Retinopathy made easy with retinal photography in Primary health care

Dorcas Musyimi, Annika Honeysett (Brien Holden Foundation)

Riverina Medical and Dental Aboriginal Corporation is one of the 155 sites selected to receive a retinal camera through the Federal Government funded Provision of Eye Health Equipment and Training (PEHET) project. The PEHET project is delivered by consortium of five organisations co-led by BHVI and Australian College of Optometry (ACO).

In this presentation, Riverina Medical and Dental Aboriginal Corporation will share their journey of embedding the use of the retinal camera into every day clinical practice – including identifying patients and creating a pathway into eye care – and the positive impact the retinal camera has had. As well as creating an increase in diabetic retinopathy screening and testing, retinal photography has created an avenue for education dialogue; it has highlighted the importance of keeping blood sugar, cholesterol and blood pressure at healthy levels to patients. Furthermore, it has provided a convincing justification of the importance regular eye testing for those who stayed away from Optometry services.

3. Early Detection of Diabetic Retinopathy using Artificial Intelligence

Leanne Scowen, Jayne Shaw (Healthcare Unlimited)

As many as 1 in 10 Aboriginal and Torres Strait Islander adults with diabetes have vision impairment due to Diabetic Retinopathy. Identifying people with diseases at an early stage can help avoid disease complications. In many cases, screening can help avoid onset of the disease altogether.

Diabetic Retinopathy is often at an advanced stage when symptoms become noticeable. The Artelus AI product not only identifies the presence of Diabetic Retinopathy but it can detect it at a very early stage.

Recognising that most AI solutions require access to the internet, Artelus developed a solution where the algorithms are embedded on chips. Geographies that don’t have internet access are no longer deprived of AI-powered healthcare screening. The algorithms read medical images in under 30 seconds and provide immediate results. The product is currently used in India, Dubai and the UK. It launched in Australia in late 2019 and currently running as a pilot site with BHVI in the Aboriginal Medical Service Redfern.

With Artelus’ state-of-the-art deep learning algorithms, clinics can provide screening for Diabetic Retinopathy in remote areas that are lacking healthcare facilities. Technology ensures wider reach and lower cost resulting in better outcomes for everyone involved in the healthcare system.

4. The Role of Accreditation in Improving Indigenous Eye Health Outcomes

Sian Lewis, Tamara McKenzie (Optometry Council Of Australia and New Zealand), Mitchell Anjou (Indigenous Eye Health)

The Institute for Urban Indigenous Health (IUIH) in South-East Queensland is home to one of Australia’s largest and fastest growing Aboriginal and Torres Strait Islander population. The IUIH Eye Health Team work towards assist in eliminating avoidable blindness due to diabetic eye disease by delivering integrated and inter-disciplinary eye health services in Aboriginal and Torres Strait Islander Community Controlled Health Services.

Aim: This presentation will outline IUIH’s key eye health initiatives and outcomes in primary, secondary and tertiary services pertaining to diabetic management.

Results: Using data extracted from a regional medical record system and individual narratives to guide strategy, the IUIH Eye Health Team are able to identify and target those 45-54yo, 55-64 yo and 65 and over who have diabetes that represent 13%, 22% and 30% of our regular Indigenous clientele. IUIH supports clients through their journey to improve engagement, uptake and attendance, and pathways into ophthalmology services for diabetic retinopathy treatment. Additionally, community engagement and awareness is sustained by a variety of eye health promotion activities that continue to be developed in partnership with the Fred Hollows Foundation.

Conclusion: With rapid population growth within the IUIH footprint, the need for integrated eye health services that focus on diabetic eye care and preventing avoidable blindness is increasing. The IUIH Eye Health Team continues to commit to the national Close the Gap goal through the delivery of optometry and ophthalmology care within a culturally responsive, holistic model.

5. Bunjils Mirring Nganga-djak Project – a partnership to increase uptake of eye exams for our community

Vanessa Murdoch, Liz Senior (EACH), Piers Carozzi (Australian College of Optometry)

EACH is a national community health service; in partnership with the Australian College of Optometry (ACO), EACH offers free eye testing(bulk-billed to Medicare) for the Aboriginal community in the Eastern suburbs of Melbourne. Uptake of these appointments has traditionally been low. We aim to demonstrate how we have increased the uptake of eye examinations in this region with the implementation of the Bunjils Mirring Nganga-djak project; a multi-faceted culturally safe framework inclusive of comprehensive eye examinations, health promotion and the provision of glasses.

6. A focus on management of diabetic eye care is key to Closing the Gap for Vision

Celia McCarthy (Institute for Urban Indigenous Health)

The Institute for Urban Indigenous Health (IUIH) in South-East Queensland is home to one of Australia’s largest and fastest growing Aboriginal and Torres Strait Islander population. The IUIH Eye Health Team work towards assist in eliminating avoidable blindness due to diabetic eye disease by delivering integrated and inter-disciplinary eye health services in Aboriginal and Torres Strait Islander Community Controlled Health Services.

Aim: This presentation will outline IUIH’s key eye health initiatives and outcomes in primary, secondary and tertiary services pertaining to diabetic management.

Results: Using data extracted from a regional medical record system and individual narratives to guide strategy, the IUIH Eye Health Team are able to identify and target those 45-54yo, 55-64 yo and 65 and over who have diabetes that represent 13%, 22% and 30% of our regular Indigenous clientele. IUIH supports clients through their journey to improve engagement, uptake and attendance, and pathways into ophthalmology services for diabetic retinopathy treatment.  Additionally, community engagement and awareness is sustained by a variety of eye health promotion activities that continue to be developed in partnership with the Fred Hollows Foundation.Conclusion: With rapid population growth within the IUIH footprint, the need for integrated eye health services that focus on diabetic eye care and preventing avoidable blindness is increasing. The IUIH Eye Health Team continues to commit to the national Close the Gap goal through the delivery of optometry and ophthalmology care within a culturally responsive, holistic model.

7. A collaborative approach to improving Aboriginal and Torres Strait Islander eye health in North Queensland

Tanya Morris (CheckUP)

To address gaps in eye health care interventions for Aboriginal and Torres Strait, NQPHN with advice from the University of Melbourne’s Indigenous Eye Health Program commissioned CheckUP to undertake service mapping and evaluate a range of eye health services within a primary health care framework.

This project focused on services to the Northern Queensland communities in and around Cairns, Mackay, the Torres Strait and the tip of Cape York. It was identified in these four regions there is no plan or coordination of Eye Health services to support the patient journey in the community to have access to Optometry and Ophthalmology services.

To establish and improve these patient pathways; this project aims to facilitate building relationships, sharing data, promoting eye care services and improving patient access amongst key stakeholders in the regions.

This presentation will outline why this initiative was undertaken with a view to explore and address the disparities of Indigenous Eye Health within the NQPHN region.

8. Developing a bulk-billed Indigenous eye care pathway in Bathurst NSW

Jane Hager (Western NSW Eye Health Partnership, NSW Rural Doctors Network)

A gap in access to eye care services exists for Indigenous patients in Bathurst was identified via ongoing feedback from Bathurst stakeholders and data analysis which demonstrated less than expected numbers of Indigenous people based on population receiving optometry services and cataract surgery. Planning analysis showed that Bathurst Indigenous patients were not traveling to access eye care services in other nearby LHDs.

Barriers identified to accessing services included lack of cultural appropriateness, cost concerns relating to spectacles and private ophthalmology clinical services, and transport.

Western NSW Eye Health Partnership members worked with Bathurst stakeholders over a period of 8 months to develop and agree on a local bulk billed eye care pathway.

MOICDP funding has recently been obtained to support:

• a part time Identified Eye Coordinator,
• cost associated with optometry and ophthalmology clinic days and,
• transport.

EESSS funding will be applied to support surgery lists for patients by this pathway and anti-VEFG medication not covered by Closing the Gap co-payments.

The model has recently commenced operating and will evolve over time. This presentation will look at the processes undertaken to develop this model and learnings to date.

9. Collaboration, Communication and Community – The Gidgee Healing Experience: creating a regional eye health model that works!

Cameron Leon, Lisa Penrose (Gidgee Healing), Tony Coburn (CheckUp)

Gidgee Healing ACCHO services a remote 55,500 sq. km area in Northwest Queensland, with 5 Primary Health Care Clinics and over 9,000 active clients (2,700 estimated to be living with diabetes). Health statistics in this region have been some of the worst in Australia, including amputation rates. With a clear vision to improve health outcomes for the local Aboriginal and Torres Strait Islander Community, since 2017 Gidgee Healing has expanded services in the region, with astounding growth in service delivery, including a 1300% increase in 715 health checks. In 2019 with the appointment of a Regional Eye Health Coordinator, a NW Qld Regional Eye Health Plan has been developed. Service delivery, referral pathways and processes have been standardised, simplified and coordinated. This presentation will focus on the eye health landscape prior to 2019, the planning stage for an integrated & coordinated eye health model, and the staged rollout from 2019-2020. The key elements to an effective regional plan, including subsidized spectacles, co-ordination, upskilling of PHC staff, integrated team care (ITC), support from Checkup, visiting optometry services and pathways to ophthalmology will be discussed. Barriers identified, solutions piloted and the importance of community consultation and engagement will all be explored.

10. Recruiting, Engaging and Retaining Participants for Health Research Studies with Aboriginal Communities: Learnings from a Population-Based Study on Type 2 Diabetes and its Eye Complications

Jose Estevez, Jayden Nguyen, Dr Natasha Howard, Dr Jamie Craig, Prof Alex Brown (South Australian Health and Medical Research Institute)

Engagement and relationship building for recruitment and retention of study participants from hard-to-reach populations require tailored approaches that consider the contextual factors of local communities. This presentation outlines the multi-targeted approach applied to support participation, community engagement, clinical integration of eye health outcomes and knowledge translation for a population-based cohort study.

The Predicting Renal, Ophthalmic and Heart Events in the Aboriginal Community (PROPHECY) study seeks to gain an understanding of the social, clinical and biological predictors of type 2 diabetes and its complications, including vision loss. The cohort recruits Aboriginal and Torres Strait Islander people living within South Australia (SA) and is known to the community as the Aboriginal Diabetes Study. A multi-targeted approach to participant recruitment and engagement is co-designed with the research team, partners and community leaders across diverse SA Aboriginal communities. Clinical integration is achieved through the detection and triaging of eye diseases, and delivery of vision correction and aggregated study findings are translated to service and community partners.

Insights into the importance of relationships, reciprocity and partnerships built around trust for mutually successful research and community outcomes are highlighted, with relevant findings on the eye health needs of the SA Aboriginal community to be explored.

11. Strengthening Eye Care Partnerships in NSW and the NT

Dian Rahardjo, Sarah Nicholls (Brien Holden Foundation)

BHVI has been providing sustainable eye care services through its Aboriginal Vision Program since 1999 (NSW) and 2000 (NT). The Program aims to create Aboriginal and Torres Strait Islander peoples’ agency while strengthening eye care services in a culturally safe manner.

In this presentation, various approaches to close gaps identified by the local community will be discussed:

• Partnerships with local and regional stakeholders
• Partnerships with other local and national organisations
• Working with various state and territory fundholders
• Taking part in advisory groups
• Providing primary care training
• Taking part in federal funded projects (PEHET)
• Increasing access to spectacles

Each community in NSW and NT present unique barriers and enablers; which will also be discussed in the presentation.

12. LookOut Project Evaluation: Service coordination success with Aboriginal Community Controlled Health Organisations in the lead

Emily Cheesman (University of Melbourne), Penelope Smith, Shaun Tatipata, Jennifer Merryweather, Jagath Happuhannadige (The Fred Hollows Foundation Indigenous Australia Program)

Evidence shows that Aboriginal communities self-determination in health is strengthened by having Aboriginal Community Controlled Health Organisations (ACCHOs) lead service coordination. This presentation will use data from the mid-point evaluation of the Lookout Project to trace the ACCHO-led coordination and expansion of Aboriginal community access to eye health services and the required resourcing and support.

Commencing in 2019, the Rural Workforce Agency Victoria (RWAV) worked with four ACCHOs and the IDEAS Van Partnership to resource and increase Aboriginal client access to access to outreach diabetic eye care services in regional Victoria (the Lookout Project). The Indigenous Australia Program of The Fred Hollows Foundation is evaluating this project. The evaluation design combines semi-structured interviews and focus groups with document analysis and will be conducted over two stages (mid-point and end). This presentation will explore the initial findings from the midpoint evaluation.

13. Keeping Up with the City Mob

Rosemary Copeland (Royal Darwin Hospital)

A snapshot of the key challenges faced by the Ophthalmology Outreach team in the Top End, Northern Territory, and how we are evolving our services to provide improved assessment and treatment for patients living in rural and remote areas.

14. KeepSight: A digital reminder system for people with diabetes

Chris Lee (Diabetes Australia), Danielle Williams (Vision 2020 Australia)

There are approximately 70,000 Aboriginal and Torres Strait Islander people living with diabetes, with around half (38,730) registered with the National Diabetes Services Scheme (NDSS). Of the 70,000 Aboriginal and Torres Strait Islander people with diabetes, one third are estimated to have diabetic retinopathy. Diabetes is the fastest growing chronic condition in Australia and all types of diabetes – type 1, type 2 and gestational – are increasing in prevalence. Aboriginal and Torres Strait Islander people are almost four times more likely than non-Indigenous Australians to have diabetes or pre-diabetes.

KeepSight is a new eye check reminder program for all Australians with diabetes – for those on the NDSS and those that are not. If facilitates a data linkage between eye health and other primary care practitioners with Diabetes Australia, to keep track of the eye health status of all Australians with diabetes. Given the risk to, and prevalence of diabetes in Aboriginal and Torres Strait Islander people, KeepSight is a vital mechanism for ensuring that eye health is adequately monitored.

15. Online education for ACCO staff

Anne-Marie Banfield, Dr Noela Prasad (VACCHO)

ACCHO staff are often in remote locations and are stretched with the demands placed on them as first the port-of-call for holistic healthcare needs of the community. This leaves little opportunity for upskilling, updating or refreshing of the knowledge and skills they might have learnt during initial training for their qualification. The development and maintenance of skills that are not used as regular parts of their clinical duties are also adversely affected by the lack of access to resources and training materials.

Online courses are a potential solution, but must be up-to-date, comprehensive and engaging to meet the needs of learners. Additionally, the format and structure of the course must be compliant with Vocational Training regulations, if a course is to be accredited.

Through creative instructional design, gamification and interactive resources the art of storytelling can be harnessed to provide Aboriginal and Torres Strait Islander health workers access to learning material that allow them to upskill and remain current in their professional skills.

Through this presentation, the strength of collaboration to deliver a novel product - Looking Deadly - will be described, to demonstrate the value of using technology to deliver online training for ACCHO staff.

16. Working Together for Health

Dr Noela Prasad (VACCHO)

Health Assessments are used as a driver to deliver a holistic approach to healthcare at ACCOs. This strength-based approach of targeted health promotion, preventative action and early diagnosis requires a flexible workforce that fits with the ACCO‘s structure and needs. Accommodating an often-changing workforce, the VACCHO team take stock of strengths and weaknesses, assessing their own capacity to be responsive, and the readiness of the ACCO’s to receive the support we can offer. Working as a tight team we engage with the ACCO’s, delivering a ‘Train the Trainer’ model to key ACCO staff.

The South-West Consortium comprises four ACCOs, Dhauwurd Wurrung Elderly and Community Health Service, Winda Mara Aboriginal Corporation, Gunditjimara Aboriginal Cooperative Ltd., and Kirrae Health Services. Each service has different levels of capacity to deliver against the health priorities each local Community. This presentation describes the process of ‘Working Together for Health’; working within ACCO’s priorities, opportunistically ‘weaving in’ support to leverage their strengths and to strengthen areas of weakness. We aim to encourage client participation in maintaining vision, hearing and speech-health, screening such as cancer screening and STI screening; early detection of risk factors such as smoking and lifestyle factors, and prevention of diseases, such as diabetes.

17. Reversing SAFE - Working with Remote Communities to promote environments that prevent trachoma

Dr Melissa Stoneham (Public Health Advocacy Institute WA, Curtin University)

As the WHO deadline to eliminate trachoma draws closer, the #endingtrachoma project has decided to invest and focus on the E within the WHO SAFE strategy. Our project works with Aboriginal Organisations who employ Aboriginal Environmental Health Workers (EHWs), regional Public Health Units and the WA Health Environmental Health Directorate to develop a sustainable approach to reducing trachoma – through environmental health change in community. We work with remote communities to develop a community driven Community Environmental Health Action Plan which identifies and plans for sustainable and realistic trachoma prevention strategies. Through this, we support locally identified projects in community such as the environmental health clinical referrals and the safe bathrooms project. The safe bathrooms is highly co-ordinated. We train EHWs to conduct bathroom and laundry assessments in homes. These assessments identify structural issues requiring maintenance to ensure a functional bathroom. The EHWs provide free soap, mirrors at child height, coloured towels and towel hooks and have a conversation with the householder about the importance of hand and face washing. We have developed a number of tools to facilitate this conversation. Within 24 hours of the assessment, Housing contractors visit the homes to rectify the plumbing issues identified in the audit. The EHWs who work and live in community, continue to follow up over time.

18. 'Who are you getting dolled up for?' Cultural influences on the effectiveness of trachoma prevention programs in Aboriginal communities in Central Australia

Tammy Abbott (Ninti One)

This research found that jealousy, attitudes, priorities and relationships are contributing factors that impact Aboriginal people when it comes to maintaining good healthy hygiene. The information gathered in the research warrants consideration of new approaches to trachoma education messaging including how they are delivered.