WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:   || 2 | 3 | 4 | 5 |   ...   | 9 |

«Victorian ophthalmology services Report on stakeholder consultation Department of Human Services HLW01 / 0363843 Victorian ophthalmology services ...»

-- [ Page 1 ] --

Final Draft

16 August 2004

Victorian ophthalmology services

Report on stakeholder consultation

Department of Human Services

HLW01 / 0363843

Victorian ophthalmology services

Report on stakeholder consultation

Table of contents

Executive summary

Overview of stakeholder views

Specific proposals for further consideration

Introduction

Background to this consultancy

Scope of the consultation

Interpreting qualitative research

Framework for this report

Eye disease in Victoria

Ophthalmology services in Victoria

Overall stakeholder comments about Victoria’s ophthalmology services

Predicted changes to ophthalmology services

Access to ophthalmology services

General access issues

Access to primary ophthalmology services

Access to the Victorian Eyecare Service

Access to secondary ophthalmology services - metropolitan

Access to secondary ophthalmology services - rural

Gaps in secondary ophthalmology service provision - rural

Access to tertiary ophthalmology services

The balance of public and private patients in public hospitals

Efficiency of ophthalmology services

Technical efficiency

Allocative efficiency

Funding and price

Appropriateness of ophthalmology services

Acceptability of ophthalmology services

Effectiveness of ophthalmology services

Safety of ophthalmology services

Governance and leadership

Consumer involvement

Competence, education and research

Education and training

Research

Information management

Future ophthalmology service system improvements

Primary ophthalmology services

Secondary and tertiary ophthalmology services

The future role of the RVEEH

Improving rural service delivery

Appropriate public/private balance

Governance and leadership

–  –  –

Conclusion

Attachments

Attachment 1: Respondents to the Department’s discussion paper

Attachment 2: Individuals and groups who participated in interviews

Attachment 3: Workshop attendees

Attachment 4: Comprehensive report of consumer consultations

Attachment 5: Quality Framework dimensions and key organisational elements...........62 Attachment 6: Key performance indicators suggested by stakeholders

–  –  –

Executive summary Overview of stakeholder views In its 2003 publication Metropolitan Health Strategy, Directions for your health care system the Victorian Department of Human Services identified the need to develop a state-wide service planning framework for ophthalmology.

This report documents the outcomes of a state-wide consultation, conducted by Phillips Fox Lawyers in conjunction with Campbell Research & Consulting, about ophthalmology services.

Together with the results of a technical planning analysis and review of ophthalmology models of care, the results of the consultation will inform the development of an Ophthalmology Service Planning Framework.

A wide range of health care professionals, health care managers, consumers and consumer advocates participated in the consultation, through face-to-face interviews, workshops and written submissions.

All stakeholders consider that the quality of ophthalmology providers in Victoria is very high and that, overall, the Victorian ophthalmology service system provides excellent service. There is, however, widespread recognition that future demand for ophthalmology services will necessitate significant changes to the service system.

Stakeholders consider that everyone should have access through the public health care system to information and preliminary assessment, but that a lack of ‘health literacy’ for clients and health providers impairs access. There is strong support for ensuring access to services by the visually impaired and the socially disadvantaged, and for the provision of free eyewear for the most vulnerable members of the community. There is also support for Government taking a more active role in eye care health promotion.

Optometrists are highly regarded for their expertise and accessibility, and are recognised by many stakeholders as an under-utilised resource. Many providers suggested that there should be clear co-management guidelines between ophthalmologists and optometrists. Many stakeholders believe that other health care professionals including general practitioners, orthoptists and nurses also have considerable potential to contribute to more efficient, effective and accessible service delivery, and there is support for establishing and evaluating new models of multi-disciplinary care.

Most general metropolitan hospitals currently provide a full range of integrated ophthalmology services (consulting, emergency and surgical). The majority of providers believe that integrated ophthalmology services should continue to be locally accessible in all general metropolitan hospitals.

Stakeholders reported significant problems with access to both outpatient and inpatient services in many public hospital settings. Waiting times for outpatient appointments in many hospitals are unacceptably high, and surgical waiting times for public patients vary considerably across the system. Combined outpatient and surgical waiting times in many major metropolitan and regional hospitals are considered to be excessive.





114357638 \ 0363843 \ HLW01 / 16 August 2004 1 Victorian ophthalmology services Report on stakeholder consultation Most regional centres provide comprehensive inpatient ophthalmology services, and some visiting surgical services are also in place in sub-regional centres. Some regional centres do not provide inpatient ophthalmology services, however, because hospitals and ophthalmologists have been unable to agree on a price for public patient surgical procedures. These regional ‘gaps’, combined with strong financial incentives for ophthalmologists to undertake fee-forservice work in smaller sub-regional and rural hospitals, have resulted in unusual patterns of referral within and between regions.

All stakeholders consider that this situation is extremely unsatisfactory and that the Ophthalmology Service Planning Framework must make provision for comprehensive services in all regional centres. Elective surgical services are considered essential to the attraction of ophthalmologists to provide medical and emergency services.

Services in sub-regional and smaller rural centres are highly valued by most stakeholders, although some stakeholders question the efficiency of a widely distributed service system, preferring instead a concentration of services at higher volume regional centres, for efficiency and quality reasons.

Some health service managers remain concerned about excessive medical costs and value for money for ophthalmology surgical services, and are seeking a higher level of direction and support from the Department of Human Services in an effort to ensure affordable services.

The Royal Victorian Eye and Ear Hospital is held in very high regard by consumers and the majority of providers, although there are concerns about excessive waiting times for outpatient services. Most providers consider that its sub-specialty clinics are an essential component of a current and future high quality tertiary service system. Its concentration of patients and academic and teaching expertise is seen as vital to continuing high standards of training.

There is a strong but not universal view amongst providers that public hospital services should complement rather than duplicate services available in the private sector, particularly for nonadmitted patient services. Consistent with this view, providers consider that the Royal Victorian Eye and Ear Hospital resources should be more actively targeted towards more complex conditions for which services are not readily accessible in the private, community-based sector, and that emergency department presentations and routine reviews for low level care should be actively triaged and referred to community-based public or private ophthalmology providers.

More active triaging of emergency patients and discharge of patients from public hospital outpatient services is seen as an essential demand management strategy for the future.

Many regional, and some metropolitan, hospitals have limited their volume of public ophthalmology operating because of concerns about its financial sustainability, with excess theatre capacity made available for the treatment of private patients, many of whom are uninsured and, therefore, self-funding. Private patient waiting times in these hospitals are often significantly less than public patient waiting times. Some health service managers are concerned about equity of access and consider that public facilities should be available solely on the basis of clinical need rather than capacity to pay, whereas others consider that the admission of higher numbers of private patients enables better use of facilities and assists in the retention of ophthalmologists, for whom public operating is financially relatively unrewarding.

While ophthalmology surgical procedures are, generally, considered to be efficient in comparison to other surgical procedures, many providers recognise that there is potential to 114357638 \ 0363843 \ HLW01 / 16 August 2004 2 Victorian ophthalmology services Report on stakeholder consultation enhance the efficiency of the system through better co-ordination of care, better use of dedicated facilities and better utilisation of optometrists, orthoptists, nurses and general practitioners. It is recognised that public teaching operating lists are slow and there is potential to replace some registrar training lists with higher volume specialist public operating lists.

There is also support for investigating a state-wide purchase of lens, with potential considerable cost savings.

Providers believe that funding for ophthalmology services is inadequate, especially in rural areas where medical costs are high, and that there should be a specific additional payment for cataract surgery in rural areas where fee-for-service applies.

Most ophthalmologists are convinced that only those patients with a justifiable clinical need are currently receiving surgery in the public system, while other providers and consumers were in favour of a more explicit system of ensuring appropriateness and prioritising need. There is also support for more systematic and transparent evaluation of clinical effectiveness, and various performance indicators were suggested for local, regional and/or state-wide adoption and monitoring.

Leadership and accountability for access, efficiency and other performance parameters currently rests mainly with individual hospitals. Generally, it was agreed that the Department of Human Services, hospitals and health care professionals have a shared interest in ensuring optimal use of resources within the system, and, therefore, a shared responsibility for leading and monitoring system-wide performance. It was agreed that governance arrangements could be instituted at a regional and/or state-wide level.

There is strong but not unanimous support for the maintenance of a specialist tertiary hospital with a concentration of highly specialised services (for efficiency and quality reasons), either in the current form of the Royal Victorian Eye and Ear Hospital or in a streamlined form, possibly more closely co-located with St Vincent’s Hospital. Under this model, most providers also support the maintenance and growth, over time, of integrated services in all general metropolitan general hospitals, and in all regional hospitals.

There was also support for reviewing the potential to collaborate with the private sector in appropriate areas to utilise existing capital and infrastructure for high volume, efficient public operating.

Specific proposals for further consideration The following suggestions were made by stakeholders during the consultation period, and

should be considered further:

General proposals Establish role delineation guidelines to guide decision-making about service provision • in hospitals of different sizes and capabilities, taking into account factors such as the importance of services to the community, and the cost and utilisation of equipment;

Consult with the Royal Victorian Eye and Ear Hospital and the Royal Australian and • New Zealand College of Ophthalmology on ongoing methods of establishing and evaluating new models of care, and on methods of monitoring and improving systemwide performance;

–  –  –

Review payments to hospitals for ophthalmology services generally, and in particular • the payment for rural services, taking into account ‘reasonableness’ of medical payments;

Consult with medical schools on the adequacy of ophthalmology education in • undergraduate training;

Consult with the Royal Australian College of General Practitioners and the Victorian • Divisions of General Practice on ways in which the ongoing competence of general practitioners in eye care can be maintained;

Invest in data collection and management systems for monitoring and improving the • ophthalmology service system, and develop a system of reporting to the Department and the community on key outcomes; and Establish a central and/or regional governance structure for ophthalmology services, • with a focus on ongoing service planning, monitoring of and responding to access, efficiency, safety, effectiveness, appropriateness and acceptability.

Proposals regarding primary ophthalmology services Enhance community education and eye care health promotion;

• Promote the establishment of eye care screening services in community-based • locations, and review the need for eye care screening services in schools;

Review the restriction on prescription of spectacles by orthoptists;

• Monitor the coverage and accessibility of the Victorian Eyecare Service;



Pages:   || 2 | 3 | 4 | 5 |   ...   | 9 |


Similar works:

«2013 ANNUAL REPORT Every kiss begins with Kay.® Every kiss begins with Kay.® Signet Jewelers is the largest specialty jewelry retailer in the US and UK. Signet’s US division operates over 1,400 stores in all 50 states primarily under the name brands of Kay Jewelers and Jared The Galleria Of Jewelry. Signet’s UK division operates approximately 500 stores primarily under the name brands of H.Samuel and Ernest Jones. Signet’s goal is to create and offer jewelry and watch products that...»

«Tenth U.S. National Conference on Earthquake Engineering Frontiers of Earthquake Engineering July 21-25, 2014 Anchorage, Alaska 10NCEE EARTHQUAKE RESILIENCE OF A 632METER SUPER-TALL BUILDING WITH ENERGY DISSIPATION OUTRIGGERS ZHOU Ying 1, ZHANG Cuiqiang2 and LU Xilin3 ABSTRACT Structural systems of super-tall buildings, including RC/SRC core walls, frames, and sometimes bracings, are utilized collaboratively to resist strong earthquakes and wind loads. Outriggers are usually set to ensure the...»

«Guidance note: Statutory Residence Test (SRT) Published August 2016 RDR3 Table of Contents Introduction How to navigate between links in this document RDR3 updates August 2016 1. Statutory residence test the basic rule Automatic overseas tests First automatic overseas test Second automatic overseas test Third automatic overseas test Do you work full-time overseas? Gaps between employments What other days can reduce the reference period? Annual leave and parenting leave What are reasonable...»

«Hyland, K. (2003). Dissertation acknowledgments: The anatomy of a Cinderella genre. Written Communication, 20, 242-268. Dissertation acknowledgements: The anatomy of a Cinderella genre Abstract Although sometimes considered to be only marginally related to the key academic goals of establishing claims and reputations, acknowledgements are commonplace in scholarly communication and virtually obligatory in dissertation writing. The significance of this disregarded “Cinderella genre” lies...»

«  1   Excerpt from Wer ist Martha? By Marjana Gaponenko Translated by Arabella Spencer I Love is cold. Love is cold. But in the grave we burn and melt to gold. Levadski waited for the tears. The tears didn’t come. In spite of this he wiped his face. Disgusting! With a fixed stare he had just put the receiver on its cradle. What else, if not impatience, had he sensed in the breathing of his family doctor? Impatience and the buzzing of thoughts that had nothing to do with him, Levadski:...»

«VISUAL SEMIOTICS: HOW STILL IMAGES MEAN? INTERPRETING STILL IMAGES BY USING SEMIOTIC APPROACHES ALEV FATOŞ PARSA aparsa@iletisim.ege.edu.tr Ege University (Turkey) Abstract Today people live in a visually intensive society and a world of spectacular and exciting images. They are bombarded with an orderly and continuously stream of visual stimulation from all manner of media every day. They see mediated images more often than they read words. Images sell everything. This paper offers an...»

«JKAU: Mar. Sci., Vol. 21, No. 2, pp: 89-108 (2010 A.D. / 1431 A.H.) DOI : 10.4197/Mar. 21-2.7 Assessment of Marine Ecosystem Degradation Based on Studying the Geological Significances of Bottom Sediments in Sharm Obhur, North Jeddah, Saudi Arabia Amin M. Gheith and Mohamed S. Hariri* Faculty of Science, Geology Department, Mansoura University, Mansoura, Egypt *Faculty of Marine Science, King Abdullaziz University, Jeddah, Saudi Arabia Abstract. Our investigations focus on the significance of...»

«Intelligence Squared U.S. -1Press Contacts: May 8, 2012 Andrea Bussell | 718.522.7171 abussell@shorefire.com Rebecca Shapiro | 718.522.7171 rshapiro@shorefire.com Mark Satlof | 718.522.717 msatlof@shorefire.com Intelligence Squared U.S. Ban college football For the Motion: Buzz Bissinger, Malcolm Gladwell Against the Motion: Tim Green, Jason Whitlock Moderator: John Donvan AUDIENCE RESULTS Before the debate: After the debate: 16% FOR 53% FOR 53% AGAINST 39% AGAINST 31% UNDECIDED 8% UNDECIDED...»

«Chapter 1 Arthur and Buster were walking up the school steps one morning when an angry voice shouted behind them, ARTHUR! ARTHUR READ! Arthur turned. Buster turned, too. The voice belonged to Francine. She was charging toward them. Muffy and Sue Ellen were with her. What's up? asked Arthur. Francine folded her arms. I'll tell you what's up. You told everyone I looked like a marshmallow. I did? 1 Buster nodded. Don't you remember, Arthur? She was wearing that goofy sweater, the one that puffs up...»

«ETSI TS 103 127 V1.1.1 (2013-05) Technical Specification Digital Video Broadcasting (DVB); Content Scrambling Algorithms for DVB-IPTV Services using MPEG2 Transport Streams 2 ETSI TS 103 127 V1.1.1 (2013-05) Reference DTS/JTC-DVB-322 Keywords DVB ETSI 650 Route des Lucioles F-06921 Sophia Antipolis Cedex FRANCE Tel.: +33 4 92 94 42 00 Fax: +33 4 93 65 47 16 Siret N° 348 623 562 00017 NAF 742 C Association à but non lucratif enregistrée à la Sous-Préfecture de Grasse (06) N° 7803/88...»

«Foundations and Trends R in Information Retrieval Vol. 5, Nos. 2–3 (2011) 103–233 c 2011 A. Nenkova and K. McKeown DOI: 10.1561/1500000015 Automatic Summarization By Ani Nenkova and Kathleen McKeown Contents 1 Introduction 104 1.1 Types of Summaries 104 1.2 How do Summarization Systems Work? 107 1.3 Evaluation Issues 114 1.4 Where Does Summarization Help? 115 1.5 Article Overview 117 2 Sentence Extraction: Determining Importance 120 2.1 Unsupervised Data-driven Methods 121 2.2 Machine...»

«Semi-Automatic Classification Plugin Documentation Release 4.8.0.1 Luca Congedo August 28, 2016 Contents I Plugin Installation 3 1 Installation in Windows 32 bit 7 1.1 QGIS download and installation................................... 7 1.2 Semi-Automatic Classification Plugin installation.......................... 7 1.3 Configuration of the plugin..................................... 8 1.4 Known...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.