optometric prescribing Flashcards
what is primary eye care
it is first contact care
as it is the first person/clinician the patient will see with an eye problem
primary care can be in opticians, pharmacy, GP or hospital
what 2 groups of staff make up the UK primary eye care work force
- specialist staff
- non specialist staff
which 2 types of clinicians make up the specialist staff in the UK primary eye care work force
- optometrists 13,766
and - ophthalmologists 3,200
which 3 types of clinicians make up the non-specialist staff in UK primary eye care work force
and why are they classed as non-specialist
- general practitioners 43,009
- A&E doctors 5,000
- community pharmacists 37,171
these people have no significant training in eye disease/care
what is the ratio of specialist staff to non-specialist staff in UK primary eye care work force
1:5
found in the A&E audit, how many patients presented with an ophthalmic problem
6.1% (minority)
how many people go to A&E with eye trauma and why
65.6% go to A&E because it is acute and painful
what eye problems that represent 21.7% go to A&E
inflammation/infection
how many % of the trauma that goes to A&E was minor, e.g. from abrasions and foreign body
80%
of patients who went to A&E with inflammation/infection, how many had conjunctivitis or blepharitis
71%
how many % of ophthalmic conditions are managed by non-specialist A&E staff
71.2%
there is no need to refer them to ophthalmology
how many % of patients who went with an eye problem was considered non acute
30.6%
was not a big problem with eye and did not need specialist emergency care
______% of patients who went to A&E with an eye problem were considered __________ to be seen by _________ ________ community ______ or _______________
37.5% of patients who went to A&E with an eye problem were considered suitable to be seen by specialist trained community GPs or optometrists
how many % of all patients who went to A&E with an eye problem were discharged on the day of presentation
62.5%
what was the most common presenting group of the population with an eye problem at the GP
children under 5 years old
what was the most common diagnosis of eye problems presented at the GP and how much % did it account for
bacterial infective conjunctivitis accounted for 41%
how many prescriptions were issued following consultation to the GP with an eye problem
70%
____% of patients visiting the GP with an eye problem were referred for __________ ____________
16 % of patients visiting the GP with an eye problem were referred for specialist treatment
what is a GPSI
general practitioner with specialist interest
a GPSI is a GP who did ______________ _____________ but did not do enough ____________ to become an ______________
a GPSI is a GP who did ophthalmology training but did not do enough training to become an ophthalmologist
why are GPSIs better at diagnosing posterior diseases over GPs
as they can use an ophthalmoscope, GPs are not trained to use an ophthalmoscope
what do GPSIs use a more broader range of
therapeutic drugs
what are the 2 most common anti-biotic drops prescribed by GPs and what are they prescribed for
chloramphenicol and fusidic acid
to treat bacterial conjunctivitis or a red eye where the GP is not sure of whats going on
what are pharmacists frequently consulted for
advice on minor eye problems e.g. conjunctivitis and dry eye
hat are pharmacists able to supply
several OTC eye preparations e.g. chloramphenicol, prop amide, anti-allergy agents and lubricants
what are patients able to do since having access to OTC medicines
treat themselves
what happened following the reclassification to OTC availability of chloramphenicol after 2005
it was prescribed more than ever before as it was supposed to now be more convenient to gain access to, however this caused higher resistance to the drug
what are the 2 scopes of optometric primary eye care
- standard (essential) optometric services
- enhanced optometric services
what 2 things is carried out by standard (essential) optometric services
- testing of sight and provision of an appropriate optical correction (GOS)
- opportunistic screening for eye disease (GOS)
what 2 things is additionally carried out by enhanced optometric services
- management of acute ophthalmic presentations
- follow up and rehabilitation of chronic conditions
what year was there a change in opticians act
2000
what did the GOC rules relating to injury or disease of the eye state in 1960 regarding optometrists
it was mandatory to refer all abnormalities of the eye
(this prevented all optoms to manage any disease as they had an obligation to refer a patient with any abnormality of the eye to a medical practitioner)
what did the GOC rules relating to injury or disease of the eye introduced in 1999 regarding optometrists
introduced discretion not to refer
what did the GOC rules relating to injury or disease of the eye introduced in 2005 regarding optometrists
a further rewording of rules
what was the change in GOC rules to injury or disease of the eye in 2005 regarding optometrists
not only can optometrists make the decision not to refer, but they can administer medical treatment also to that patient.
so the optometrist is under no legal obligation to refer every patient.
they use their discretion to decide if this patient needs referring.
they have the authority and legal ability to manage the patient themselves.
but they need to work in their limits of competence and training.
as stated in the GOC rules to injury or disease of the eye in 2005, if an optometrists does decide not to refer a patient, what 2 things must they do
- shall record in respect of the person consulting him:
- a sufficient description of the injury or disease from which the person appears to be suffering
- his reason for deciding not to refer on that occasion
- details of the advice or medical or clinical treatment tendered to the patient - if appropriate, and with the consent of the person consulting him, shall inform the persons general practitioner of those matters recorded in accordance with the previous rule (1)
what changes occurred to the medicines legislation and the optometrist in 1999
publication of crown review
what changes occurred to the medicines legislation and the optometrist in 2000
changes to GOC rules
patient group directions
what changes occurred to the medicines legislation and the optometrist in 2005
changes to entry level exemptions
additional supply and supplementary prescribing
what changes occurred to the medicines legislation and the optometrist in 2008
independent prescribing
what are the 2 most common ocular conditions currently managed by optometrists frequently
- dry eyes (70% of optoms)
- blepharitis/lid problems (70% of optoms)
followed by, simply corneal abrasion, allergic conjunctivitis and infective conjunctivitis is the least
all these conditions can be managed by more optometrists if they had further training
what type of eye conditions do optometrists rarely manage
sight threatening
what condition did optometrists who many could diagnose, also said that with further training they could also manage
primary open angle glaucoma
followed by dendritic ulcer and acute anterior uveitis
what is the most common therapeutic agent most frequently recommended or supplied by UK optometrists
ocular lubricants
what is the most common therapeutic agent NEVER recommended or supplied by the UK optometrists
NAIDS
what is the most common therapeutic agent occasionally recommended or supplied by UK optometrists
anti-infectives
list 3 enhanced service pathways being commissioned across the UK
and what is the benefit of implementing these enhanced services
- glaucoma repeat measures
- glaucoma referral refinement
- primary eyecare
benefit is reduction in referral rates
who organises and authorises the primary care and acute referral scheme
clinical commissioning group
what is the benefit of the primary care and acute referral scheme
optometrists are paid an additional fee for performing particular services e.g. if someone has glaucoma, rather than referring them with minimal info, the optometrist can perform additional tests first as this exhibits appropriate optometric referrals and more patients can be managed in optometric practice
list the 7 specific requirement for clinical equipment for the minor eye condition scheme (MECS)
- slit lamp
- volk or similar lens
- contact tonometer
- visual field equipment capable of producing a plot
- eyelash removal instruments
- ambler charts
- diagnostic medication
list the 4 stages that consist of the optometrist training for the minor eye condition scheme MECS
- distance learning modules (online training)
- practical assessment - on GAT, volk etc
- HES casualty placement - optoms meet ophthalmologists
- accreditation is received
what was the most common reason by optometrists for participation of the locally commissioned enhanced optometric services
to further their professional development
what was a frequently given reason by optometrists for non-participation of the locally commissioned enhanced optometric services
the lack of fit with the ‘retail’ business model or optometry
list the 4 different sources that the optometrists receives referral for the minor eye condition scheme MECS
- GP
- pharmacist
- self referral (from leaflets etc)
- converted from GOS (a standard eye test converted into MECS)
list the 3 possible routes that an optometrist performing a minor eye condition scheme MECS for a patient can take with a patient
- discharge no treatment
- refer to HES
- treatment by optometrist (if they treat then they can discharge)
what is the next stage for the patient after treatment by optometrists with the minor eye condition scheme MECS
review by optometrist
what are the 2 possible routes that an optometrist can take following a minor eye condition scheme MECS for a patient after review by the optometrist following treatment
- if resolved, can discharge
- if gets worse, refer to HES
what is the most common reason for a patient coming for an eye test in the first place
- red eye
followed by
- painful white eye
- flashes and floaters
- loss of vision
- headaches
- trauma
- diplopia
what is the most common reason for visit that can be managed by an optometrist with the minor eye condition scheme MECS
- red eye
followed by
- painful white eye
- flashes/floaters (as most won’t have a RD)
- loss of vision
- trauma
- diplopia (these mostly have to be referred to HES is its unexplained and sudden)
following a visit to the optometrist in the minor eye condition scheme MECS, what is the most common diagnosis made my the optom
eyelid, lacrimal system, orbit - as a cause of the red eye
what was the most common form of management following a minor eye condition scheme MECS visit
- management of ocular pathology in practice
followed by
- discharge/no ocular pathology
- referral to HES
- referral to GP (referred back if it was an associated medical problem with the eye problem in order to do further checks)
