iCareTracking: Optimising the appropriateness of glaucoma and diabetic eyecare delivery by Australian optometrists

The intervention is a quality improvement program for optometrists that will be delivered over a 3-month period. The program is comprised of the clinical self-assessment (self-audit of clinical records), peer support activities, education activities and resources. There are three arms to the trial (1) Glaucoma (2) Diabetic eye disease (3) control. Both the glaucoma and diabetic eye disease arms are intervention groups. The clinical self-assessment is delivered online via the iCareTrack Assessment of appropriateness Clinical practice Tool (i-ACT). The i-ACT consists of 45 and 33 clinical indicators (measurable components of guideline recommendations with inclusion criteria and compliance action) for glaucoma and diabetic eye disease, respectively. The clinical indicators are stratified by the domains of history taking, physical examinations, management, recall and referral. Optometrists will access the secure online portal to complete their self-assessment. Optometrists will complete at least three i-ACT cycles of self-assessment of the appropriateness of care delivery (entry, mid-point, and final). The self-assessments will occur at the following timepoints: entry (within week 1 to week 2 of the intervention period), mid-point (within week 6 to week 7), and final (within week 11 to week 12). A minimum of ten patient records will be assessed in each cycle taking approximately 2 hours/cycle. At the end of each self-assessment cycle, feedback will be provided. Feedback will be the overall and domain appropriateness percentages for their assessment which will be benchmarked to both normative and realistic benchmarks. Adherence to i-ACT self-assessment cycles will be monitored via web-portal analytics. For peer support, optometrists will participate in a minimum of one of the three offered condition-specific interactive case study webinars facilitated by the researchers with subject matter experts (either ophthalmologists or optometrists) presenting the case studies. Thus, participants in the glaucoma arm will attend one of three offered glaucoma case study webinars and participants in the diabetes arm will attend one of three offered diabetic eye disease case study webinars. The duration of each webinar is one hour. One webinar per condition (i.e., one glaucoma and one diabetes) will be offered every month during the intervention period. The webinars will be interactive, with participants able to participate in the discussion. Adherence to webinar participation will be monitored by registration and attendance logs. Educational activities comprise of video lectures and case studies on appropriate glaucoma and diabetic eyecare available on the online portal. These educational activities have been specifically designed for the study. Resources consist of a combination of those designed specifically for the study (e..g., checklists, risk factor lists) as well as URL links to external resources. External sources for Diabetes : (1) Centre for Eye Health Chair-Side Reference Diabetic Retinopathy, (2) Optometry Australia Clinical Guidelines for Examination and Management of Patients with Diabetes, (3) University of Melbourne Diabetic Grading course https://drgrading.iehu.unimelb.edu.au/cera/index.asp) (4) Eye Can Do it Patient Education (https://www.eyecandoit.org/EYECanDoIt.pdf): External sources for Glaucoma: (1) Optometry Australia Clinical Practice Guide for Diagnosis and management of Open-Angle Glaucoma, (2) RANZCO Clinical Practice Guidelines for the Collaborative Care of glaucoma patients and suspects by ophthalmologists and optometrists in Australia, (3) GONE Project (http://www.gone-project.com/), and (4) Glaucoma Australia Collaborative Care Referral Response Pathway (https://glaucoma.org.au/i-treat-glaucoma). Both the educational activities and resources are optional activities that the optometrists will access as required. Regardless of group allocation (intervention or control), at the completion of the intervention, an external assessor will conduct an assessment of your clinical records for patients with diabetes and/or patients with or at risk of glaucoma. For the intervention groups, a minimum of twenty (20) records of either diabetic patients or patients with or at risk of glaucoma (depending on their allocation) will be randomly sampled and assessed (minimum of 10 clinical records from a 4-week period prior to the intervention start date and a minimum of 10 clinical records from the 4-week period after intervention completion.