Clinical audit as an educative tool for optometrists

Sena A Gocuk, Ji-hyun Lee, Peter R Keller, Lauren N Ayton, Robyn H Guymer, Allison M McKendrick and Laura E Downie. Ophthalmic & Physiological Optics. 2020. https://doi.org/10.1111/opo.12754

A/Prof Laura Downie, Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia was a recipient of a $100,000 MDFA Research Grant in 2015. Her research has now been published in the prestigious Ophthalmic & Physiological Optics journal. The purpose of the research project was to investigate whether performing a clinical audit and receiving analytical performance feedback altered documentation of age-related macular degeneration (AMD) care provided by optometrists.

Clinical audits are recognised as a quality improvement process and a key component in healthcare delivery and evidence-based practice. A/Prof Downie explained, “the ultimate aim of a clinical audit is to improve the provision of patient care”.

“Although there are currently no formal requirements regarding clinical audit in optometry in Australia, there is increasing recognition of its value for improving practice; this is arguably of heightened importance for sight-threatening conditions, such as AMD.”

MaD-CCAT

A/Prof Downie and her team developed the Macular Degeneration Clinical Care Audit Tool (MaD-CCAT) and asked participants to audit their clinical records, for patients with or at risk of AMD, over a three-month period.  Participants then received quantitative analytical data summarising the relative compliance of their clinical record keeping relative to current best-practice. From this information participants self-identified five key areas for self-improvement and provided this data to researchers. The researchers provided the option for relevant research papers to be given to participants but provided no additional education or support. After an additional three months, participants again used the MaD-CCAT for a subsequent set of patients to provide post-audit data. A/Prof Downie advised that “the MaD-CCAT is a custom built audit tool for optometrists and uses an intuitive online platform, to enable an audit to be easily completed using a computer, laptop or smartphone”.

The study showed that, optometric clinical care of AMD patients improved documentation of risk factors, clinical examination, AMD severity classification and management advice. Self-audit and analytical feedback demonstrated an improvement in post-audit documentation for AMD family history (94% to 100%, p=0.03), smoking status (21% to 58%, p<0.01), diet (11% to 29%, p<0.01) and nutritional supplementation (20% to 51%, p<0.01). 

Reflecting on the importance of this research A/Prof Downie stated that “in the absence of a cure for AMD, reducing the risk of a person developing sight-threatening late-stage AMD, is immensely important”.

“Optometrists, as primary eye care providers, have the opportunity to ask patients about these modifiable factors, and to provide appropriate counselling with respect to how these factors relate to an individual’s AMD risk. This is the first study to evaluate the value of clinical audit, with analytical feedback, as an educative tool for altering documentation of the care provided to people with AMD. We found that self-audit improved clinical record documentation of several aspects of optometric care which will help ensure the best clinical outcomes for patients.”

Posted: 1 February 2021