Indigenous access to cataract surgery: an assessment of the barriers and solutions within the Australian health system.

BACKGROUND: To identify barriers in the health systems that limit access to cataract surgery for Indigenous Australians and present strategies to overcome these barriers.
DESIGN: Interview and focus group-based qualitative study. PARTICIPANTS: Five hundred thirty participants were consulted in semi-structured interviews, focus group discussions and stakeholder workshops.
METHODS: Semi-structured interviews with a cross-section of health-care professionals, eye care practitioners, primary health-care workers, hospital staff and health department staff were conducted in 21 site locations. Focus group discussions with clients from seven Aboriginal Health Services in Victoria were conducted. Stakeholder workshops included Aboriginal Community Controlled Health sector, eye care sector, government departments and non-government organizations. A total of 279 semi-structured interviews were conducted in the Northern Territory, New South Wales, Queensland, South Australia, Victoria and Western Australia. Three stakeholder workshops were held. MAIN OUTCOME MEASURES: Barriers and solutions to increase access to cataract surgery for Indigenous Australians.
RESULTS: Analysis of the participant responses identified health system barriers at primary care, specialist care and hospital levels. These included: long waiting times, cost of surgery, complexity of the steps involved in treatment, lack of surgical capacity and low awareness of regional eye health needs. Strategies to overcome these barriers involve a system-wide approach to increase provision and utilization of services.
CONCLUSION: The need for surgery is real and services need to expand beyond current levels. The solutions for overcoming barriers to cataract surgery could be used as a model for other health interventions which rely on close interaction between primary and specialist care services.