optometric prescribing

Question 1

what is primary eye care

Answer 1

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

Question 2

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

Answer 2

• specialist staff

- non specialist staff

Question 3

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

Answer 3

• optometrists 13,766
  and
• ophthalmologists 3,200

Question 4

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

Answer 4

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

these people have no significant training in eye disease/care

Question 5

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

Answer 5

1:5

Question 6

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

Answer 6

6.1% (minority)

Question 7

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

Answer 7

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

Question 8

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

Answer 8

inflammation/infection

Question 9

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

Answer 9

80%

Question 10

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

Answer 10

71%

Question 11

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

Answer 11

71.2%

there is no need to refer them to ophthalmology

Question 12

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

Answer 12

30.6%

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

62.5%

Question 15

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

Answer 15

children under 5 years old

Question 16

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

Answer 16

bacterial infective conjunctivitis accounted for 41%

Question 17

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

Answer 17

70%

Question 18

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

Answer 18

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

Question 19

what is a GPSI

Answer 19

general practitioner with specialist interest

Question 20

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

Answer 20

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

Question 21

why are GPSIs better at diagnosing posterior diseases over GPs

Answer 21

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

Question 22

what do GPSIs use a more broader range of

Answer 22

therapeutic drugs

Question 23

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

Answer 23

chloramphenicol and fusidic acid

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

Question 24

what are pharmacists frequently consulted for

Answer 24

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

Question 25

hat are pharmacists able to supply

Answer 25

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

Question 26

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

Answer 26

treat themselves

Question 27

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

Answer 27

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

Question 28

what are the 2 scopes of optometric primary eye care

Answer 28

- standard (essential) optometric services | - enhanced optometric services

Question 29

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

Answer 29

- testing of sight and provision of an appropriate optical correction (GOS) - opportunistic screening for eye disease (GOS)

Question 30

what 2 things is additionally carried out by enhanced optometric services

Answer 30

- management of acute ophthalmic presentations | - follow up and rehabilitation of chronic conditions

Question 31

what year was there a change in opticians act

Answer 31

2000

Question 32

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

Answer 32

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)

Question 33

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

Answer 33

introduced discretion not to refer

Question 34

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

Answer 34

a further rewording of rules

Question 35

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

Answer 35

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.

Question 36

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

Answer 36

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)

Question 37

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

Answer 37

publication of crown review

Question 38

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

Answer 38

changes to GOC rules | patient group directions

Question 39

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

Answer 39

changes to entry level exemptions | additional supply and supplementary prescribing

Question 40

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

Answer 40

independent prescribing

Question 41

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

Answer 41

- 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

Question 42

what type of eye conditions do optometrists rarely manage

Answer 42

sight threatening

Question 43

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

Answer 43

primary open angle glaucoma | followed by dendritic ulcer and acute anterior uveitis

Question 44

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

Answer 44

ocular lubricants

Question 45

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

Answer 45

NAIDS

Question 46

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

Answer 46

anti-infectives

Question 47

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

Answer 47

- glaucoma repeat measures - glaucoma referral refinement - primary eyecare benefit is reduction in referral rates

Question 48

who organises and authorises the primary care and acute referral scheme

Answer 48

clinical commissioning group

Question 49

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

Answer 49

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

Question 50

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

Answer 50

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

Question 51

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

Answer 51

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

Question 52

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

Answer 52

to further their professional development

Question 53

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

Answer 53

the lack of fit with the 'retail' business model or optometry

Question 54

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

Answer 54

- GP - pharmacist - self referral (from leaflets etc) - converted from GOS (a standard eye test converted into MECS)

Question 55

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

Answer 55

- discharge no treatment - refer to HES - treatment by optometrist (if they treat then they can discharge)

Question 56

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

Answer 56

review by optometrist

Question 57

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

Answer 57

- if resolved, can discharge | - if gets worse, refer to HES

Question 58

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

Answer 58

- red eye followed by - painful white eye - flashes and floaters - loss of vision - headaches - trauma - diplopia

Question 59

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

Answer 59

- 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)

Question 60

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

Answer 60

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

Question 61

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

Answer 61

- 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)