Rewarding yet challenging: factors influencing domiciliary optometry services in Australian long-term care communities

CLINICAL RELEVANCE: A thorough understanding of the challenges involved in practising in long-term care communities is essential to enhance optometric engagement with this sector. BACKGROUND: Vision impairments are common among older adults living in long-term care communities. However, significant gaps in access and utilisation of eyecare services exist in this setting. This study explored the barriers and enablers faced by optometrists to provide domiciliary eyecare services in long-term care. METHODS: A qualitative descriptive approach was adopted. Twenty-seven Australian optometrists (16 with long-term care experience) participated in interviews or focus groups, guided by the theoretical domains framework. The sessions were audio recorded, transcribed, coded deductively and inductively, and analysed iteratively to form themes. RESULTS: Five themes emerged, highlighting several barriers at macro/ system-level (e.g. regulatory gaps, workforce shortage), meso/ organisational level (e.g. environment, poor care coordination) and micro/ practitioner-patient-family level (e.g. capabilities, competing priorities). Enablers included positive beliefs about socio-professional responsibilities, experience managing complex conditions, confidence in clinical skills and practising in non-traditional settings, knowledge of referral practices, and job satisfaction. Recommendations to overcome barriers included financial incentives, peer-support, and mentoring opportunities, an enabling environment in aged care, centralised health records, and collaborative models of care involving aged care staff, health professionals, and families. CONCLUSION: Multifaceted challenges hinder eyecare in long-term care. The findings highlight the need for advocacy and a systems-thinking approach to build capacity, enhance care coordination, and optimise funding for domiciliary optometry to improve eye and health outcomes for people in long-term care. The study recommendations align with the Integrated People-Centred Health Services framework of the World Health Organization, offering opportunities for further development.