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Therapeutics > optometric prescribing > Flashcards

optometric prescribing Flashcards

1
Q

what is primary eye care

A

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

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2
Q

what 2 groups of staff make up the UK primary eye care work force

A
  • specialist staff

- non specialist staff

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3
Q

which 2 types of clinicians make up the specialist staff in the UK primary eye care work force

A
  • optometrists 13,766
    and
  • ophthalmologists 3,200
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4
Q

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

A
  • general practitioners 43,009
  • A&E doctors 5,000
  • community pharmacists 37,171

these people have no significant training in eye disease/care

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5
Q

what is the ratio of specialist staff to non-specialist staff in UK primary eye care work force

A

1:5

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6
Q

found in the A&E audit, how many patients presented with an ophthalmic problem

A

6.1% (minority)

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7
Q

how many people go to A&E with eye trauma and why

A

65.6% go to A&E because it is acute and painful

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8
Q

what eye problems that represent 21.7% go to A&E

A

inflammation/infection

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9
Q

how many % of the trauma that goes to A&E was minor, e.g. from abrasions and foreign body

A

80%

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10
Q

of patients who went to A&E with inflammation/infection, how many had conjunctivitis or blepharitis

A

71%

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11
Q

how many % of ophthalmic conditions are managed by non-specialist A&E staff

A

71.2%

there is no need to refer them to ophthalmology

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12
Q

how many % of patients who went with an eye problem was considered non acute

A

30.6%

was not a big problem with eye and did not need specialist emergency care

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13
Q

______% of patients who went to A&E with an eye problem were considered __________ to be seen by _________ ________ community ______ or _______________

A

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

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14
Q

how many % of all patients who went to A&E with an eye problem were discharged on the day of presentation

A

62.5%

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15
Q

what was the most common presenting group of the population with an eye problem at the GP

A

children under 5 years old

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16
Q

what was the most common diagnosis of eye problems presented at the GP and how much % did it account for

A

bacterial infective conjunctivitis accounted for 41%

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17
Q

how many prescriptions were issued following consultation to the GP with an eye problem

A

70%

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18
Q

____% of patients visiting the GP with an eye problem were referred for __________ ____________

A

16 % of patients visiting the GP with an eye problem were referred for specialist treatment

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19
Q

what is a GPSI

A

general practitioner with specialist interest

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20
Q

a GPSI is a GP who did ______________ _____________ but did not do enough ____________ to become an ______________

A

a GPSI is a GP who did ophthalmology training but did not do enough training to become an ophthalmologist

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21
Q

why are GPSIs better at diagnosing posterior diseases over GPs

A

as they can use an ophthalmoscope, GPs are not trained to use an ophthalmoscope

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22
Q

what do GPSIs use a more broader range of

A

therapeutic drugs

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23
Q

what are the 2 most common anti-biotic drops prescribed by GPs and what are they prescribed for

A

chloramphenicol and fusidic acid

to treat bacterial conjunctivitis or a red eye where the GP is not sure of whats going on

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24
Q

what are pharmacists frequently consulted for

A

advice on minor eye problems e.g. conjunctivitis and dry eye

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25
Q

hat are pharmacists able to supply

A

several OTC eye preparations e.g. chloramphenicol, prop amide, anti-allergy agents and lubricants

26
Q

what are patients able to do since having access to OTC medicines

A

treat themselves

27
Q

what happened following the reclassification to OTC availability of chloramphenicol after 2005

A

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

28
Q

what are the 2 scopes of optometric primary eye care

A
  • standard (essential) optometric services

- enhanced optometric services

29
Q

what 2 things is carried out by standard (essential) optometric services

A
  • testing of sight and provision of an appropriate optical correction (GOS)
  • opportunistic screening for eye disease (GOS)
30
Q

what 2 things is additionally carried out by enhanced optometric services

A
  • management of acute ophthalmic presentations

- follow up and rehabilitation of chronic conditions

31
Q

what year was there a change in opticians act

A

2000

32
Q

what did the GOC rules relating to injury or disease of the eye state in 1960 regarding optometrists

A

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)

33
Q

what did the GOC rules relating to injury or disease of the eye introduced in 1999 regarding optometrists

A

introduced discretion not to refer

34
Q

what did the GOC rules relating to injury or disease of the eye introduced in 2005 regarding optometrists

A

a further rewording of rules

35
Q

what was the change in GOC rules to injury or disease of the eye in 2005 regarding optometrists

A

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.

36
Q

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

A
  1. 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
  2. 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)
37
Q

what changes occurred to the medicines legislation and the optometrist in 1999

A

publication of crown review

38
Q

what changes occurred to the medicines legislation and the optometrist in 2000

A

changes to GOC rules

patient group directions

39
Q

what changes occurred to the medicines legislation and the optometrist in 2005

A

changes to entry level exemptions

additional supply and supplementary prescribing

40
Q

what changes occurred to the medicines legislation and the optometrist in 2008

A

independent prescribing

41
Q

what are the 2 most common ocular conditions currently managed by optometrists frequently

A
  • 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

42
Q

what type of eye conditions do optometrists rarely manage

A

sight threatening

43
Q

what condition did optometrists who many could diagnose, also said that with further training they could also manage

A

primary open angle glaucoma

followed by dendritic ulcer and acute anterior uveitis

44
Q

what is the most common therapeutic agent most frequently recommended or supplied by UK optometrists

A

ocular lubricants

45
Q

what is the most common therapeutic agent NEVER recommended or supplied by the UK optometrists

A

NAIDS

46
Q

what is the most common therapeutic agent occasionally recommended or supplied by UK optometrists

A

anti-infectives

47
Q

list 3 enhanced service pathways being commissioned across the UK
and what is the benefit of implementing these enhanced services

A
  • glaucoma repeat measures
  • glaucoma referral refinement
  • primary eyecare

benefit is reduction in referral rates

48
Q

who organises and authorises the primary care and acute referral scheme

A

clinical commissioning group

49
Q

what is the benefit of the primary care and acute referral scheme

A

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

50
Q

list the 7 specific requirement for clinical equipment for the minor eye condition scheme (MECS)

A
  • slit lamp
  • volk or similar lens
  • contact tonometer
  • visual field equipment capable of producing a plot
  • eyelash removal instruments
  • ambler charts
  • diagnostic medication
51
Q

list the 4 stages that consist of the optometrist training for the minor eye condition scheme MECS

A
  • distance learning modules (online training)
  • practical assessment - on GAT, volk etc
  • HES casualty placement - optoms meet ophthalmologists
  • accreditation is received
52
Q

what was the most common reason by optometrists for participation of the locally commissioned enhanced optometric services

A

to further their professional development

53
Q

what was a frequently given reason by optometrists for non-participation of the locally commissioned enhanced optometric services

A

the lack of fit with the ‘retail’ business model or optometry

54
Q

list the 4 different sources that the optometrists receives referral for the minor eye condition scheme MECS

A
  • GP
  • pharmacist
  • self referral (from leaflets etc)
  • converted from GOS (a standard eye test converted into MECS)
55
Q

list the 3 possible routes that an optometrist performing a minor eye condition scheme MECS for a patient can take with a patient

A
  • discharge no treatment
  • refer to HES
  • treatment by optometrist (if they treat then they can discharge)
56
Q

what is the next stage for the patient after treatment by optometrists with the minor eye condition scheme MECS

A

review by optometrist

57
Q

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

A
  • if resolved, can discharge

- if gets worse, refer to HES

58
Q

what is the most common reason for a patient coming for an eye test in the first place

A
  • red eye

followed by

  • painful white eye
  • flashes and floaters
  • loss of vision
  • headaches
  • trauma
  • diplopia
59
Q

what is the most common reason for visit that can be managed by an optometrist with the minor eye condition scheme MECS

A
  • 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)
60
Q

following a visit to the optometrist in the minor eye condition scheme MECS, what is the most common diagnosis made my the optom

A

eyelid, lacrimal system, orbit - as a cause of the red eye

61
Q

what was the most common form of management following a minor eye condition scheme MECS visit

A
  • 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)

Therapeutics (19 decks)

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