Eyes On The Outback: The Challenge Of Providing Specialist Ophthalmic Services In Remote NSW, Australia

1. Ashish Agar^1,2
2. Joanna Barton¹
3. Elyssa Brennan¹
4. Minas Coroneo^1,2

¹Outback Eye Service, Prince of Wales Hospital, Sydney, Australia
²Department of Ophthalmology, University of New South Wales, Sydney, Australia

PURPOSE: The provision of ophthalmic services to remote rural & indigenous communities in Australia is crucial to their health. Isolated districts of NSW have been the focus of a free formalised Outback Eye Service (OES) started a decade ago. The evolution of this program is reviewed and challenges identified.

METHOD: An audit of the OES was performed using hospital and clinic data from the 6 remote sites. Medical and paramedical staff, including outside the service, were interviewed to identify challenges faced and strategies required to address them.

RESULTS: The main challenges were 1. Maintaining follow-up and co-ordination of chronic disease patients and patient education while being cognisant of cultural issues, 2. Co-ordination with para-medical eyecare providers, 3. Ensuring ongoing funding while dealing with unco-ordinated Federal and State government bodies, 4. Constraints on transport due to over-bureaucratisation, & 5. Dealing with a lack of insight in regional health administration. Nonetheless through various strategies the service has grown. Patient numbers increased over the study period by an average of 28% (10-45%). Numbers of indigenous patients seen increased by 50%, and as a proportion of the total rose from 25% to 30%. The service was highly valued by local communities.

CONCLUSION: The OES is subject to clinical and administrative challenges. While some are unique, others are common to publicly funded specialist programs irrespective of disciplines and geography. This service has successfully negotiated some of these, but greater understanding at all levels is required to provide optimal ophthalmic care in these special settings.