title: Participant referral rate in the National Eye Health Survey (NEHS).
abstract: OBJECTIVE
  To present the rates of referral of participants in the National Eye Health Survey (NEHS) for further eye care.
  
  
  METHODS
  A national sample of 3098 non-Indigenous Australians aged 50-98 and 1738 Indigenous Australians aged 40-92 years living in 30 randomly selected sites was recruited using a door-to-door approach. Participants completed a general questionnaire and a series of eye tests, including vision and anterior segment assessment, intra-ocular pressure measurement, visual field testing and fundus photography. A predefined protocol was used to guide the referral of participants for follow up eye care. An ophthalmologist was on-call to assist with the triaging of participants.
  
  
  RESULTS
  Of the total sample, 32.1% (994/3098) of non-Indigenous participants and 43.6% (757/1738) of Indigenous participants were referred for further eye care (p<0.001). A significant difference in referral rates for Indigenous Australians was observed between regions of differing geographic remoteness [range = 32.2% (Inner Regional)-60.4% (Very Remote), p <0.001]. After adjusting for covariates, males (OR = 1.24, 95% CI: 1.06-1.46), older age (OR = 1.02 per year, 95% CI: 1.01, 1.02) and longer time since previous eye examination (OR = 1.15 per year, 95% CI: 1.12, 1.19) were associated with higher rates of eye care referral in the non-Indigenous population. In the Indigenous population, older age (OR = 1.02 per year, 95% CI: 1.01-1.03), self-reported diabetes (OR = 1.70, 95% CI: 1.37-2.12), greater geographical remoteness (OR = 1.19, 95% CI: 1.09-1.29) and longer time since previous eye examination (OR = 1.10 per year, 95% CI: 1.07, 1.13) were associated with a higher rate of referral after multivariate adjustments. A total of 25 participants (1.4%) were referred for urgent follow-up of potentially sight threatening conditions.
  
  
  CONCLUSIONS
  Our data has identified several high risk groups that required ophthalmic referral including older Australians, non-Indigenous men, Indigenous Australians with self-reported diabetes and those residing in very remote populations who may benefit from improvements in the provision and/or uptake of eye health services. Future longitudinal research is warranted to evaluate the feasibility and efficacy of implementing a referral protocol within a population-based research setting.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Stuart
authors.initials: S
authors.lastname: Keel
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Pei Ying
authors.initials: PY
authors.lastname: Lee
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.|Department of Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Foreman
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.|Department of Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: van Wijngaarden
authors.affiliation: Indigenous Eye Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Hugh R
authors.initials: HR
authors.lastname: Taylor
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Dirani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005128:Eye Diseases / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012424:Rural Population; D015351:Vision Screening