title: Increasing the impact of teleophthalmology in Australia: Analysis of structural and economic drivers in a state service.
abstract: OBJECTIVE
  Despite its potential to improve service provision for country patients, teleophthalmology is currently underused in Australia. There is an associated lack of cost-effectiveness data for teleophthamology.
  
  
  METHODS
  Retrospective and prospective hospital-based clinical audits of 5456 patients; descriptive survey of available telehealth equipment in 129 regional facilities; cost calculations for teleophthalmology, patient transfers and outreach services.
  
  
  METHODS
  Primary (optometry, general practice [GP], Aboriginal Medical Service [AMS]) and secondary (hospital) sites in regional Western Australia; a tertiary hospital in Perth.
  
  
  METHODS
  Proportion of patients suitable for teleophthalmology; proportion of regional practices with telehealth technology; capital expenditure to equip regional practices for teleophthalmology; total savings from increased utilisation of teleophthalmology.
  
  
  METHODS
  Advocacy for funding, regulatory, training and infrastructure recommendations, in order to support efficient models of teleophthalmology.
  
  
  RESULTS
  A total of 15% and 24% of urgent patient transfers and outreach consultations, respectively, were found to be suitable for teleophthalmology, equating to a potential total cost saving of $1.1 million/year. Capital expenditure required for basic telehealth equipment was negligible for optometrists, compared to $20 500 per GP/AMS practice. Successful advocacy led to funding, training and policy changes to support optometry-led teleophthalmology for country patients in Australia.
  
  
  CONCLUSIONS
  Public-private partnerships can result in significant cost-savings for the Australian health system. Targeted, evidence-based advocacy can inform government health reforms.
authors.affiliation: Lions Eye Institute, Perth, Western Australia, Australia.
authors.forename: Hessom
authors.initials: H
authors.lastname: Razavi
authors.affiliation: Lions Eye Institute, Perth, Western Australia, Australia.
authors.forename: Stephen Paul
authors.initials: SP
authors.lastname: Copeland
authors.affiliation: Lions Eye Institute, Perth, Western Australia, Australia.
authors.forename: Angus Warwick
authors.initials: AW
authors.lastname: Turner
mesh_terms: D001315:Australia; D005128:Eye Diseases / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009907:Optometry / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics*; D012424:Rural Population / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000191:economics* / Q000706:statistics & numerical data
keywords: Indigenous health; health service evaluation; ophthalmology; rural health; telemedicine