Clinical indicators for diabetic eyecare delivered by optometrists in Australia: a Delphi study

ABSTRACT

Clinical relevance

Valid and updated clinical indicators can serve as important tools in assessing and improving eyecare delivery.

Background

Indicators for diabetic eyecare in Australia were previously developed from guidelines published before 2013 and then used to assess the appropriateness of care delivery through a nationwide patient record card audit (the iCareTrack study). To reflect emerging evidence and contemporary practice, this study aimed to update clinical indicators for optometric care for people with type 2 diabetes in Australia.

Methods

Forty-five candidate indicators, including existing iCareTrack and new indicators derived from nine high-quality evidence-based guidelines, were generated. A two-round modified Delphi process where expert panel members rated the impact, acceptability, and feasibility of the indicators on a 9-point scale and voted for inclusion or exclusion of the candidate indicators was used. Consensus on inclusion was reached when the median scores for impact, acceptability, and feasibility were ≥7 and >75% of experts voted for inclusion.

Results

Thirty-two clinical indicators with high acceptability, impact and feasibility ratings (all median scores: 9) were developed. The final indicators were related to history taking (n = 12), physical examination (n = 8), recall period (n = 5), referral (n = 5), and patient education/communication (n = 2). Most (14 of 15) iCareTrack indicators were retained either in the original format or with modifications. New indicators included documenting the type of diabetes, serum lipid level, pregnancy, systemic medications, nephropathy, Indigenous status, general practitioner details, pupil examination, intraocular pressure, optical coherence tomography, diabetic retinopathy grading, recall period for high-risk diabetic patients without retinopathy, referral of high-risk proliferative retinopathy, communication with the general practitioner, and patient education.

Conclusion

A set of 32 updated diabetic eyecare clinical indicators was developed based on contemporary evidence and expert consensus. These updated indicators inform the development of programs to assess and enhance the eyecare delivery for people with diabetes in Australia.

KEYWORDS:

• Appropriate care
• clinical indicators
• Delphi study
• diabetic macular oedema
• diabetic retinopathy

Acknowledgements

Rajendra Gyawali was supported through a UNSW Scientia PhD Scholarship. Melinda Toomey was supported through an Australian Government Research Training Program Scholarship and a University of New South Wales (UNSW) Scientia PhD Scholarship. The results from this study were presented at ARVO conference 2022 and abstract published in the conference proceedings.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/08164622.2023.2253792.

Additional information

Funding

This work was supported by the Diabetes Australia Research Trust [Y21G-JALI].