title: Optometric use of a teleophthalmology service in rural Western Australia: comparison of two prospective audits.
abstract: BACKGROUND
  Lions Outback Vision provides a telehealth service ('the telehealth service') to rural and remote communities in Western Australia aiming to deliver timely ophthalmic care to this underserved population. A number of barriers to its use were identified by an initial prospective audit. A multifaceted intervention was designed to increase the use of the telehealth service by optometrists.
  
  
  METHODS
  Optometrists referred patients from rural and remote Western Australia to the telehealth service. Two five-month prospective audits of the telehealth service were compared. The first, in 2012, was prior to the implementation of the intervention. The second, in 2014, was during the period of the intervention, which included logistical support, remuneration to optometrists, a more user-friendly referral pathway and awareness raising. The outcome measures were the number of consultations conducted during the two audit periods and other quantitative changes to the telehealth service.
  
  
  RESULTS
  After implementation of the intervention, use of the telehealth service increased 3.5 fold. A greater percentage of referrals were for non-urgent conditions (145 [69 per cent] versus 16 [32 per cent], p < 0.001) and less consultations recommended follow up with an ophthalmologist in clinic (42 [20 per cent] versus 17 [28 per cent], p = 0.04). Imaging studies were frequently used to supplement information provided by the referrer to the specialist during both audit periods.
  
  
  CONCLUSIONS
  Optometrists used the telehealth service more frequently after the implementation of an intervention that addressed the barriers to its use. This has a number of potential benefits to rural and remote ocular health service provision in Australia.
authors.affiliation: Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
authors.forename: Roderick
authors.initials: R
authors.lastname: O'Day
authors.affiliation: University of Western Australia, Perth, Australia.
authors.forename: Constance
authors.initials: C
authors.lastname: Smith
authors.affiliation: Lions Eye Institute, Perth, Australia.
authors.forename: Josephine
authors.initials: J
authors.lastname: Muir
authors.affiliation: University of Western Australia, Perth, Australia. angus.turner@gmail.com.|Lions Eye Institute, Perth, Australia. angus.turner@gmail.com.
authors.forename: Angus
authors.initials: A
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005128:Eye Diseases / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009907:Optometry / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation; D012424:Rural Population / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology
keywords: ophthalmology; optometry; telehealth; telemedicine