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Monday, November 29, 2021

New standard to improve care for Australians with cataract

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The first national standard of care for patients with cataract will streamline how patients are prioritised for the most common elective surgery in Australia – and ultimately improve access to care.

Cataract is a leading cause of vision impairment and occurs when the clear eye lens degenerates and becomes opaque.

When cataract is first identified it may not need surgery, but about 50 per cent of older Australians are likely to develop significant cataract by their 70s.

Each year more than 250,000 people undergo cataract surgery to replace the eye lens with an artificial one.

Almost 70 per cent of these surgeries are performed in private hospitals.

Many more Australians await cataract surgery, with admission to public hospitals in areas with socioeconomic disadvantage more than double that of wealthier areas.

Last week’s release of the Cataract Clinical Care Standard by the Australian Commission on Safety and Quality in Health Care (the Commission) will help to define clear pathways of care so that decisions about cataract surgery are more consistent nationally and based on clinical need.

Conjoint Professor Anne Duggan, Commission Chief Medical Officer, said the new standard would ensure cataract treatment is appropriate and more efficient, with patients who are more likely to benefit from surgery being clearly identified.

“With increasing demand for cataract surgery due to improved surgical methods and an ageing population, it’s never been more important to ensure that we have the right care pathways,” she said.

“We need to ensure that cataract patients are prioritised for surgery or non-surgical alternatives based on both clinical need and individual circumstances. An additional benefit will be reduced public hospital waiting times.”

During the COVID pandemic, the necessary suspension of non-urgent elective surgery in some states and territories has delayed cataract surgeries, and led to growing waiting lists.

“While the standard was in development before the pandemic, COVID has increased the need for us to work together across the healthcare system to manage prioritisation for cataract surgery, with the common goal of improving the efficiency, effectiveness and equity of care,” Duggan said.

Care for people with cataract begins with the initial assessment and referral by a general practitioner, optometrist or specialist clinic.

The Cataract Clinical Care Standard highlights the importance of ensuring that both visual impairment and a person’s individual situation are considered in decisions about surgery.

“Without robust systems for managing referrals, we have a mixture of patients being referred to public hospital clinics – those in obvious need of the procedure and others who are unsuitable or unwilling to have it,” Duggan said.

“One way to address this would be to improve referral and triage processes.

“If we get better at sharing knowledge at the referral stage, this will enable clinicians and health service organisations to identify patients at risk from delayed surgery and their relative priority.

“Improving our referral, assessment and prioritisation process for cataract is central to the new clinical care standard.”

Additionally, Duggan said the new standard would help to balance the disparity in cataract care.

This would lead to more efficient and equitable access to care for people in areas of socio-economic disadvantage, as well as Aboriginal and Torres Strait Islander peoples.

Concerning findings in the Second Australian Atlas of Healthcare Variation 2017, which examined the occurrence of cataract across the country, led to the development of the Cataract Clinical Care Standard.

Similar to other high income countries, Australia has seen an upswing in rates of cataract surgery in the past 25 years.

High volumes of cataract surgery are performed in Australia, which has twice the rate of cataract surgery (8000 per million) compared to New Zealand, although lower than France, the Netherlands and the United States.

However, the Atlas found uneven access to care across Australia, with significant geographic variation in rates nationally.

Putting patients at the centre of cataract care

According to Duggan, providing more clarity and certainty to patients should be a priority for all health professionals.

“The patient-centred Cataract Clinical Care Standard provides a clear framework to deliver more consistent and evidence-based care to people with cataract,” she said.

“The new standard supports a more uniform approach to managing patients with cataract right across Australia, so we can consistently deliver a better standard of health care.

“It is designed to facilitate a more informed discussion between the patient and their GP or other healthcare professional around the management of cataract.

“With this standard, the patient is placed firmly at the centre of the cataract journey – as they should be.”

For more than a decade, Tracy Siggins, Director of Ambulatory Care at The Royal Victorian Eye and Ear Hospital, has been at the helm of improvements at the Melbourne facility.

During this time, the team has introduced innovative ways to prioritise cataract patients, leading to a 79 per cent decrease in patients waiting for assessment.

She said applying standardised referral criteria for both referrers and triaging staff has been critical in supporting The Royal Victorian Eye and Ear Hospital to deliver timely cataract care to patients.

“Our experience has shown it’s crucial to have a clearly documented approach, which provides clarity to triage patients based on their clinical needs,” Siggins said.

“The quality of the referral received is key to the effectiveness of the referral management processes.

“The primary driver for our hospital to increase capacity and see more new patients was the development of standardised post-operative pathways.

“These changes have helped to remove bottlenecks and made a substantial difference to our level of patient care,” Siggins added.

The new standard has been launched via a live-streamed event.

The panel discussion was hosted by GP Dr Liz Marles and included the Commission’s Conjoint Professor Anne Duggan and Tracy Siggins from The Royal Victorian Eye and Ear Hospital.

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