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Article ; Online: Knowledge translation for the everyday optometrist.

Toomey, Melinda / Jalbert, Isabelle

2021 Volume 104, Issue 7, Page(s) 744–755

Abstract: A gap exists between best evidence and actual clinical care provided to patients. The advent of evidence-based practice was meant to address this gap by providing practitioners with a method to search, evaluate and incorporate evidence into practice. ... ...

Abstract	A gap exists between best evidence and actual clinical care provided to patients. The advent of evidence-based practice was meant to address this gap by providing practitioners with a method to search, evaluate and incorporate evidence into practice. However, the gap continues to exist. The health research fields of
MeSH term(s)	Evidence-Based Practice ; Humans ; Implementation Science ; Optometrists ; Surveys and Questionnaires ; Translational Medical Research
Language	English
Publishing date	2021-04-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	639275-1
ISSN	1444-0938 ; 0816-4622
ISSN (online)	1444-0938
ISSN	0816-4622
DOI	10.1080/08164622.2021.1898275
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Article ; Online: Enhancing the appropriateness of eyecare delivery: the iCaretrack approach.

Gyawali, Rajendra / Toomey, Melinda / Stapleton, Fiona / Keay, Lisa / Jalbert, Isabelle

Clinical & experimental optometry

2023 Volume 106, Issue 8, Page(s) 825–835

Abstract: Optometrists play an integral role in primary eyecare services, including prevention, diagnosis, and management of acute and chronic eye conditions. Therefore, it remains essential that the care they provide be timely and appropriate to ensure the best ... ...

Abstract	Optometrists play an integral role in primary eyecare services, including prevention, diagnosis, and management of acute and chronic eye conditions. Therefore, it remains essential that the care they provide be timely and appropriate to ensure the best patient outcomes and optimal utilisation of resources. However, optometrists continuously face many challenges that can affect their ability to provide appropriate care (i.e., the care in line with evidence-based clinical practice guidelines). To address any resulting evidence-to-practice gaps, programs are needed that support and enable optometrists to adopt and utilise the best evidence in clinical practice. Implementation science is a field of research that can be applied to improving the adoption and maintenance of evidence-based practices in routine care, through systematic development and application of strategies or interventions to address barriers to evidence-based practice. This paper demonstrates an approach using implementation science to enhance optometric eyecare delivery. A brief overview of the methods used to identify existing gaps in appropriate eyecare delivery is presented. An outline of the process used to understand the behavioural barriers responsible for such gaps follows, involving theoretical models and frameworks. The resulting development of an online program for optometrists to enhance their capability, motivation, and opportunity to provide evidence-based eyecare is described, using the Behaviour Change Model and co-design methods. The importance of and methods used in evaluating such programs are also discussed. Finally, reflections on the experience and key learnings from the project are shared. While the paper focuses on experiences in improving glaucoma and diabetic eyecare in the Australian optometry context, this approach can be adapted to other conditions and contexts.
MeSH term(s)	Humans ; Australia ; Evidence-Based Practice ; Glaucoma ; Optometrists ; Optometry/methods
Language	English
Publishing date	2023-02-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639275-1
ISSN	1444-0938 ; 0816-4622
ISSN (online)	1444-0938
ISSN	0816-4622
DOI	10.1080/08164622.2023.2178286
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Article ; Online: Developing realistic benchmarks for glaucoma care delivery.

Toomey, Melinda / Gyawali, Rajendra / Ho, Kam Chun / Stapleton, Fiona / Keay, Lisa / Jalbert, Isabelle

Clinical & experimental optometry

2023 Volume 107, Issue 2, Page(s) 196–203

Abstract: Clinical relevance: Realistic benchmarks can serve as comparators for optometrists wishing to engage in clinical practice audits of their glaucoma care.: Background: The iCareTrack study established the appropriateness of glaucoma care delivery ... ...

Abstract	Clinical relevance: Realistic benchmarks can serve as comparators for optometrists wishing to engage in clinical practice audits of their glaucoma care. Background: The iCareTrack study established the appropriateness of glaucoma care delivery through clinical record audits of Australian optometry practices. Benchmarks required for monitoring and improving glaucoma care delivery do not exist. This study developed realistic benchmarks for glaucoma care and then benchmarked the performance of practices from the iCareTrack study to establish aspects of care that warrant attention from quality improvement initiatives. Methods: Benchmarks were developed from the pre-existing iCareTrack dataset using the Achievable Benchmarks of Care (ABC) method. The iCareTrack study had audited the appropriateness of glaucoma care delivery against 37 clinical indicators for 420 randomly sampled glaucoma patient records from 42 Australian optometry practices. The four-step ABC method calculates benchmarks based on the top 10% of best-performing practices adjusted for low patient encounter numbers. iCareTrack results were compared to the benchmarks to explore the distribution of practices that were at, above or below benchmark. Results: Benchmarks were developed for 34 of 37 iCareTrack indicators. For 26 (of 34) indicators, the benchmarks were at or above 90% appropriateness. The benchmarks for 14 (of 34) iCareTrack indicators were met by more than 80% of eligible practices, indicating excellent performance. Some aspects of glaucoma care such as peripheral anterior angle assessment, applanation tonometry, and visual field assessment appeared to be delivered sub-optimally by optometrists when compared to the benchmarks. Conclusion: This study established benchmarks for glaucoma care delivery in optometry practices that reflect realistic and top achievable performance. The large number of indicators with benchmarks above 90% confirmed that glaucoma care can and should be delivered by optometrists at very high levels of appropriateness. Benchmarking identified pockets of sub-optimal performance that can now be targeted by quality improvement initiatives.
MeSH term(s)	Humans ; Benchmarking/methods ; Australia ; Glaucoma/therapy ; Delivery of Health Care ; Optometry/methods
Language	English
Publishing date	2023-11-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	639275-1
ISSN	1444-0938 ; 0816-4622
ISSN (online)	1444-0938
ISSN	0816-4622
DOI	10.1080/08164622.2023.2275748
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Article ; Online: Building and maintaining interprofessional collaborative practice in eyecare: Learnings from the Queensland Paediatric Optometry Alignment Program.

Webber, Ann L / Toomey, Melinda / Keay, Lisa / Dai, Shuan / Gole, Glen A / Newcomb, Dana / McKinlay, Lynne

Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)

2023 Volume 44, Issue 1, Page(s) 52–70

Abstract: Purpose: The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional ... ...

Abstract	Purpose: The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional collaboration and the facilitators that contribute to its success, and assessed changes in optometrists' satisfaction since the pilot phase of the collaborative care programme. Methods: Qualitative deductive and inductive content analysis was applied to open-ended free-text survey responses collected in 2018 from the optometrists involved in the Program's pilot phase. The responses were coded using the Theoretical Domains Framework (TDF) to categorise barriers and facilitators into key themes. Key behavioural determinants were mapped to the COM-B (Capability, Opportunity, Motivation-Behaviour) elements of the Behaviour Change Wheel model to identify intervention strategies. Intervention recommendations were derived from behaviour change mapping and compared with programme quality improvement initiatives. A cross-sectional explanatory survey informed by the TDF was conducted within the current 2023 cohort, and a longitudinal comparative analysis was carried out using data from the 2018 survey. Results: Among the 97 surveys distributed in 2018, 44 respondents participated; from this group, 38 individuals contributed a total of 200 free-text responses. Facilitators (240 comments) outnumbered barriers (65 comments). Key facilitators were accessible and timely care, professional development, confidence and positive outcome beliefs. Barriers included communication, information handover, credibility, relationships and skill gaps. Optometrists actively engaged in the programme in 2023 reported heightened satisfaction with their involvement, increased confidence and greater engagement in paediatric eyecare delivery. However, challenges in clinical information transfer persist. Conclusion: The interprofessional collaborative model of paediatric eyecare has contributed efficiencies within the health system by building paediatric care capacity in the community, fostering professional credibility and promoting interdisciplinary trust. Insights gained should prove valuable for other paediatric eyecare services exploring hospital-to-community care models.
MeSH term(s)	Humans ; Child ; Optometry ; Queensland ; Cross-Sectional Studies ; Optometrists ; Learning
Language	English
Publishing date	2023-11-27
Publishing country	England
Document type	Journal Article
ZDB-ID	604564-9
ISSN	1475-1313 ; 0275-5408
ISSN (online)	1475-1313
ISSN	0275-5408
DOI	10.1111/opo.13246
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Article ; Online: Multiple things going on at the same time: determinants of appropriate primary diabetic eyecare delivery.

Gyawali, Rajendra / Toomey, Melinda / Stapleton, Fiona / Keay, Lisa / Chun Ho, Kam / Jalbert, Isabelle

Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)

2021 Volume 42, Issue 1, Page(s) 71–81

Abstract: Purpose: A recent nationwide medical record audit of optometry practices has identified an evidence-to-practice gap in primary diabetic eyecare delivery. This study aimed to explore the determinants (barriers and enablers) to appropriate diabetic ... ...

Abstract	Purpose: A recent nationwide medical record audit of optometry practices has identified an evidence-to-practice gap in primary diabetic eyecare delivery. This study aimed to explore the determinants (barriers and enablers) to appropriate diabetic eyecare delivery in Australia. Methods: A qualitative study involving focus-group discussions and interviews of a purposeful sample of Australian optometrists was conducted. Participants were asked about the perceived barriers to adherence to four underperforming clinical indicators related to primary diabetic eyecare identified by the recent national optometry practice audit. The Theoretical Domain Framework was used for thematic analysis and coding salience to identify key behavioural determinants. Results: Optometrists participated in eight focus groups (n = 27) and individual interviews (n = 4). The most salient barriers were related to Environmental resources (e.g., limited chair time); Beliefs about consequences (e.g., lack of perceived importance); Knowledge (e.g., poor understanding); Professional role/identity (e.g., the perceived role of optometry in care process); Social influences (e.g., the influence of senior optometrists) and Intentions (e.g., apathy). Key enablers were Environmental resources (e.g., electronic record system and practice aids); Knowledge (e.g., keeping up with knowledge/professional development); reinforcements (e.g., fear of legal actions) and behavioural regulations (e.g., self-monitoring/audit). Conclusions: This study shows that the evidence-to-practice gap in primary diabetic eyecare delivery in Australia can be attributed in part to several interconnected factors related to optometrists' individual capability and motivation as well as the social and practice environment within which they sit. These behavioural determinants will inform the design of an intervention to improve the appropriateness of primary diabetic eyecare delivery.
MeSH term(s)	Australia ; Diabetes Mellitus ; Humans ; Motivation ; Optometrists ; Qualitative Research
Language	English
Publishing date	2021-11-08
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604564-9
ISSN	1475-1313 ; 0275-5408
ISSN (online)	1475-1313
ISSN	0275-5408
DOI	10.1111/opo.12912
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Article ; Online: Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework.

Toomey, Melinda / Gyawali, Rajendra / Stapleton, Fiona / Ho, Kam Chun / Keay, Lisa / Jalbert, Isabelle

Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)

2021 Volume 41, Issue 4, Page(s) 782–797

Abstract: Purpose: Evidence-based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence-based eye care delivery has been reported. Given the important role of ... ...

Abstract	Purpose: Evidence-based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence-based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery. Recent findings: PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were 'environmental context and resources' (time, resources, equipment issues, patient factors), 'knowledge' (awareness issues), 'skills' (skills proficiency) and 'belief about consequences' (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling. Summary: The barriers and facilitators identified in this review were diverse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery.
MeSH term(s)	Delivery of Health Care ; Humans ; Optometrists ; Primary Health Care ; Surveys and Questionnaires
Language	English
Publishing date	2021-03-28
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	604564-9
ISSN	1475-1313 ; 0275-5408
ISSN (online)	1475-1313
ISSN	0275-5408
DOI	10.1111/opo.12801
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Article ; Online: The appropriateness of and barriers to glaucoma care delivery by Australian optometrists.

Toomey, Melinda / Ho, Kam Chun / Gyawali, Rajendra / Stapleton, Fiona / Wiles, Louise / Hibbert, Peter / Keay, Lisa / Jalbert, Isabelle

Clinical & experimental optometry

2022 Volume 105, Issue 6, Page(s) 593–601

Abstract: Clinical relevance: Establishing the level of appropriateness and barriers to glaucoma care delivery by Australian optometrists are important first steps in developing tailored interventions aimed at improving glaucoma care delivery.: Background: To ... ...

Abstract	Clinical relevance: Establishing the level of appropriateness and barriers to glaucoma care delivery by Australian optometrists are important first steps in developing tailored interventions aimed at improving glaucoma care delivery. Background: To determine the appropriateness of and barriers to glaucoma care by optometrists. Methods: A mixed method study was conducted. Phase I was a retrospective cross-sectional medical record audit that assessed glaucoma care appropriateness against 37 clinical indicators from a nationally representative sample of 42 optometry practices. In Phase II, focus groups and interviews involving 31 optometrists explored audit findings to identify barriers to appropriate glaucoma care. Barriers were analysed by deductive and inductive qualitative analysis. Saliency analysis was used to identify key domains that influence glaucoma care. Results: Appropriate glaucoma care was delivered for 63% (95% CI 61%, 64%) of the 420 patient encounters audited. Appropriate care was delivered above 80% for most (57%) indicators, while 14 (38%) indicators were delivered below 60% appropriateness. Good compliance to appropriate care was noted for key indicators of intraocular pressure measurement (90%, 95% CI 87%, 93%) and optic nerve head/retinal nerve fibre layer imaging (78%, 95% CI 74%, 82%). Important barriers identified were beliefs about expected outcomes, lack of perceived relevancy, time constraints, poor organisational culture, knowledge gaps, focusing on some aspects of glaucoma care to the detriment of others, the complexity of glaucoma care, information recall, and social norms. Conclusion: Glaucoma care was appropriate in most patient encounters, with opportunity to improve some aspects of history taking and physical examinations. Barriers to glaucoma care were diverse, existing at both the practitioner and organisational levels. These findings provide direction for the development of a tailored improvement intervention.
MeSH term(s)	Australia ; Glaucoma/diagnosis ; Glaucoma/therapy ; Humans ; Optometrists ; Optometry/methods ; Retrospective Studies
Language	English
Publishing date	2022-01-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	639275-1
ISSN	1444-0938 ; 0816-4622
ISSN (online)	1444-0938
ISSN	0816-4622
DOI	10.1080/08164622.2021.2004861
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Article ; Online: Level of appropriate primary diabetic eyecare delivered and achievable in optometry practices in Australia.

Gyawali, Rajendra / Ho, Kam Chun / Toomey, Melinda / Stapleton, Fiona / Keay, Lisa / Hibbert, Peter / Wiles, Louise / Jalbert, Isabelle

Clinical & experimental optometry

2022 Volume 106, Issue 3, Page(s) 276–282

Abstract: Clinical relevance: Current levels of appropriateness for primary diabetic eyecare delivered by Australian optometrists are presented along with realistic targets (benchmarks) for quality improvement. The demonstrated methods can be used in practice ... ...

Abstract	Clinical relevance: Current levels of appropriateness for primary diabetic eyecare delivered by Australian optometrists are presented along with realistic targets (benchmarks) for quality improvement. The demonstrated methods can be used in practice evaluation and benchmarking of other clinical practice areas and settings. Background: To examine the appropriateness of diabetic eye-care delivery and establish achievable benchmarks of care (ABCs) for optometry practices in Australia. Method: In a retrospective audit, clinical records of patients with type-II diabetes obtained from a randomly selected nationally representative sample of optometry practices were assessed against evidence-based clinical indicators. Appropriate care is defined as care delivered in compliance with the indicators. The ABC for each indicator was calculated as the average performance for the top 10% of optometry practices after Bayesian adjustment to account for a low number of eligible records. Results: The audit of 420 randomly selected patient records from 42 practices against 12 clinical indicators showed an overall appropriateness of 69% (95% confidence interval (CI) 66%, 73%) for overall diabetic eye care. While a high level of appropriateness was identified for recall period (93%, 95% CI 85%, 100%) and referral (100%, 95% CI 38%, 100%), larger gaps existed in history taking (46%, 95% CI 44%, 52%), dilated fundus examination (80%, 95% CI 76%, 84%) and iris examination (0%, 95% CI 0%, 56%). The ABCs for 8 of 12 indicators were 100%, and the remaining three indicators had ABCs above 80%. An ABC for the iris examination indicator could not be calculated owing to the low number of eligible patient record cards. Conclusions: This study demonstrated a systematic process of practice evaluation and benchmarking in optometry practices. The diabetic eye care delivered by Australian optometrists was largely appropriate; however, improvement opportunities exist for history taking and physical examination. The ABCs demonstrate that excellence in primary diabetic eye care is attainable and will serve as an important tool in future initiatives to reduce the identified evidence-to-practice gaps.
MeSH term(s)	Humans ; Optometry ; Retrospective Studies ; Bayes Theorem ; Australia/epidemiology ; Benchmarking/methods ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/therapy
Language	English
Publishing date	2022-02-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	639275-1
ISSN	1444-0938 ; 0816-4622
ISSN (online)	1444-0938
ISSN	0816-4622
DOI	10.1080/08164622.2022.2033107
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Article ; Online: Quality of 2019 American optometric association clinical practice guideline for diabetic eye care.

Gyawali, Rajendra / Toomey, Melinda / Stapleton, Fiona / Dillon, Lisa / Zangerl, Barbara / Keay, Lisa / Jalbert, Isabelle

Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)

2020 Volume 41, Issue 1, Page(s) 165–170

Abstract: Purpose: The 2019 American Optometric Association (AOA) clinical practice guideline intends to assist optometrists in providing evidence-based eye care for people with diabetes. This technical report evaluated the methodological and reporting quality of ...

Abstract	Purpose: The 2019 American Optometric Association (AOA) clinical practice guideline intends to assist optometrists in providing evidence-based eye care for people with diabetes. This technical report evaluated the methodological and reporting quality of the guideline. Methods: Four independent reviewers appraised the 2014 and 2019 versions of the AOA's guideline using the AGREE II instrument. Average scaled scores across the six domains of the AGREE II and an overall independent score were calculated based on the formula provided. Results: The 2019 guideline scored high (range: 75-93%) in all domains except for the domain of applicability (34%). In the domain of rigour of development, significant improvements were noted in the 2019 guideline (median score: 7.0, interquartile range (IQR): 6.0-7.0) compared to the 2014 guideline (median: 5.0, IQR: 4.0-6.0) (p < 0.0001). The appraisal of the guideline also identified room for further improvements, especially in relation to implementing the guideline. Conclusion: The overall and domain specific quality of the AOA 2019 guideline was high, however, improvement in its applicability domain is required. The findings of this study will aid uptake of the guideline and inform improvement efforts for other international optometric guidelines.
MeSH term(s)	Diabetic Retinopathy/diagnosis ; Diabetic Retinopathy/therapy ; Humans ; Optometrists/standards ; Optometry/organization & administration ; Practice Guidelines as Topic/standards ; Quality Assurance, Health Care/methods ; Societies, Medical/standards ; Surveys and Questionnaires ; United States
Language	English
Publishing date	2020-11-18
Publishing country	England
Document type	Journal Article
ZDB-ID	604564-9
ISSN	1475-1313 ; 0275-5408
ISSN (online)	1475-1313
ISSN	0275-5408
DOI	10.1111/opo.12763
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Article ; Online: Quality of the Australian National Health and Medical Research Council's clinical practice guidelines for the management of diabetic retinopathy.

Gyawali, Rajendra / Toomey, Melinda / Stapleton, Fiona / Zangerl, Barbara / Dillon, Lisa / Keay, Lisa / Liew, Gerald / Jalbert, Isabelle

Clinical & experimental optometry

2021 Volume 104, Issue 8, Page(s) 864–870

Abstract: ... Clinical ... ...

Abstract	Clinical relevance
MeSH term(s)	Australia ; Biomedical Research ; Canada ; Diabetes Mellitus ; Diabetic Retinopathy/therapy ; Humans ; Ophthalmology ; Practice Guidelines as Topic/standards
Language	English
Publishing date	2021-02-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639275-1
ISSN	1444-0938 ; 0816-4622
ISSN (online)	1444-0938
ISSN	0816-4622
DOI	10.1080/08164622.2021.1880862
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