Optometry and Vision Sciences - Theses

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    The utility of clinical audit and point-of-care tools to support optometric evidence-based practice in age-related macular degeneration
    Gocuk, Sena Ayse ( 2021)
    Age-related macular degeneration (AMD) is a leading cause of vision impairment worldwide. Currently, there are no approved therapies for earlier stages of AMD. Furthermore, treatments available for later stages of the disease may not reverse vision loss. Of key importance for reducing patients’ risk of progression to sight-threatening late-stage AMD, is the early identification and management of modifiable risk factors. Optometrists in Australia have a key role in providing primary eye care to people who are at risk of developing, or who have earlier stages of, AMD. They are therefore ideally placed to ask and counsel their patients about lifestyle modifications that can reduce the risk of disease progression. Our research team has recently developed the Macular Degeneration Clinical Care Audit Tool (MaD-CCAT), which is designed to audit the optometric care provided to people with AMD, relative to current best-practice standards. The first research project described in this thesis used self-audit data, collected by optometrists using the MaD-CCAT, to both characterise current optometric AMD practice patterns, and evaluate whether the process of clinical self-audit and receiving analytical feedback could improve AMD care. The second project involved a randomised, placebo-controlled trial to evaluate the efficacy of a novel AMD point-of-care clinical tool, delivered either in hardcopy (paper) or online format, for improving optometrists’ AMD knowledge and documented clinical care. In the first project it was found that there are several areas for improvement relating to optometrists’ documentation patterns for key areas relating to AMD care. In addition, self-audit with feedback significantly improved optometrists’ clinical record documentation, including: AMD risk factors, clinical examination techniques, AMD severity classification, and management, post-audit. The optometric practice patterns observed in this study were used to inform the development of two new AMD clinical tools designed to support evidence-based care. In the second study, use of the point-of-care AMD clinical tools, particularly in a paper-based format, was found to improve clinical record documentation, post-intervention (p<0.05), for documenting: patients’ current smoking status, nutritional supplementation intake, accurate AMD severity classification, discussing patient’s risk of progression to late-stage AMD, and providing advice regarding appropriate dietary and nutritional supplementation intake. Clinical self-audit with analytical feedback is a valuable method for improving clinical record documentation of key aspects of AMD care provision by optometrists. Furthermore, AMD point-of-care clinical tools, particularly in a paper-based format assist in documentation of patient risk factors, AMD severity classification, and facilitating communication with patients regarding modifiable risk factor advice. These studies provide insight into the efficacy of different clinical methods for enhancing optometric AMD care provision, to align with current, best available research evidence.