Evaluation of an ear health pathway in remote communities: improvements in ear health access.

OBJECTIVE: Reduce long waiting lists for ear, nose and throat (ENT) specialist review and improve primary ear health care. DESIGN: A retrospective evaluation of ear health care after the implementation of an ear health program (EHP). SETTING AND PARTICIPANTS: School children in Aboriginal communities in the Fitzroy Valley of Western Australia. KEY MEASURES FOR IMPROVEMENT: Access number of children screened for ear disease, effectiveness-referral letter completeness (history, otoscopy, tympanometry, audiometry), patient management and waiting time until first ENT contact. INTERVENTIONS: EHP--an electronic referral template, ear health nurse, ear health educator and telehealth ENT specialist review. MAIN OUTCOME MEASURES: Screening rates, timely ENT review and improved primary care management. RESULTS: Number of children screened increased from 148 per 18 months to 710. Nearly twofold increase in numbers of patients referred to ENT (32, 66). A reduction in median waiting time from 141 days to 22 days for ENT review using telehealth. Content of referral letters showed an increase in essential information--otoscopy, audiometry and tympanometry. Primary care management in accordance with guidelines improved. CONCLUSIONS: The addition of an ear health team increased access to appropriate primary care management and the time to contact with ENT was reduced by using an electronic template and telehealth sessions.