Increasing the impact of teleophthalmology in Australia: Analysis of structural and economic drivers in a state service.

Problem: 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.

Design: 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.

Setting: Primary (optometry, general practice [GP], Aboriginal Medical Service [AMS]) and secondary (hospital) sites in regional Western Australia; a tertiary hospital in Perth.

Key Measures For Improvement: 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.

Strategies For Change: Advocacy for funding, regulatory, training and infrastructure recommendations, in order to support efficient models of teleophthalmology.

Effects Of Change: 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.

Lessons Learnt: Public-private partnerships can result in significant cost-savings for the Australian health system. Targeted, evidence-based advocacy can inform government health reforms.