Download Prescribing - Glasgow Caledonian University

Therapeutic Prescribing for Optometrists: an initial
perspective
Gunter Loffler1, Ross Henderson2, Stephen Bolland3 & Gael E. Gordon1
1 Department
of Vision Sciences, Glasgow Caledonian University,
Cowcaddens Road, Glasgow G4 0BA, Scotland, UK.
2 WJ Henderson Optometrist,
59 South Methven Street, Perth, PH1 5NX, Scotland, UK.
3 SevenSeventeen Projects,
16 Cuthill Towers, Milnathort, KY13 9SE, Scotland, UK
Abstract
Aim:
Recent legislative changes in the UK permit optometrists with additional
training to be involved in the therapeutic management of eye conditions. The
role of a therapeutic optometrist within the health care network is still
developing and it seems timely to ascertain what impact this additional role
has on those who have undertaken the relevant training. This article aims to
capture a snapshot of the current status of therapeutic prescribing for
optometrists in the UK.
Methods:
All UK optometrists qualified as Additional Supply (AS) and Independent
Prescribing (IP), as well as those undertaking training towards therapeutic
prescribing, were invited to take part in an online survey. Questions
concerned their perception of the training requirements, the conditions
therapeutically qualified optometrists treat, the drugs they use, how often they
prescribe and the general impact for their patients and their practice.
Results:
Sixty optometrists completed the questionnaire. Thirty-eight respondents are
qualified as independent prescribers (IP), which represents 60% of all
currently registered IP optometrists in the UK at February 2011.
i) All parts of the training (theoretical and clinical placement) were rated
highly; the course content and duration were judged appropriate to prepare for
the role of an independently prescribing optometrist.
ii) Respondents manage a wide range of conditions (including blepharitis,
allergic eye disease, corneal problems, uveitis and glaucoma) with an
extensive range of ophthalmic drugs (including antivirals and topical steroid).
iii) On average, optometrists issue 10 prescriptions per month.
iv) Feedback from patients, general practitioners and ophthalmologists has
been positive; the number of onwards referrals has reduced.
Conclusions:
1
This survey provides the first insight on the impact of therapeutic qualifications
on optometric practice as the participants are part of the first cohort to have
qualified. Therapeutic optometrists regard the training as beneficial for their
practice, their clinical confidence and for patients.
Introduction
Legislation
Since the first recognition via the Medicines Act in 1968 [1] that UK-based
optometrists could be generally involved in the use of medicines, legislation in
this regard has changed on a number of occasions. Prior to 1999,
optometrists had access to a range of diagnostic and therapeutic medicines,
specified in Level 1 or 'entry level' exemptions to the Medicines Act [2]. This
allowed all registered optometrists access to a number of prescription-only
medicines (POM) such as Chloramphenicol, Cyclopentolate, Pilocarpine and
Atropine1 without undergoing additional training.
Dr June Crown’s Review of Prescribing, Supply and Administration of
Medicines [3] resulted in her recommendation that general prescribing should
be extended to certain non-medically qualified professionals, including
optometrists. In 2000, the NHS plan [4] endorsed this recommendation on the
understanding that it would provide patients with quicker and more efficient
access to medicines, as well as making better use of the skills of health
professionals.
This has resulted in an increased range of medicines available to optometrists
through further exemptions to the Medicines Act. To permit access to a wider
range of POMs and to establish prescribing partnerships with Independent
Prescribers, two further levels of exemption were introduced, both of which
require additional training and qualifications. Since July 2005, optometrists on
the Additional Supply (AS) or Supplementary Prescribing (SP) register can
supply and administer additional medicines which will allow them to manage a
number of common non-sight threatening disorders (AS) or to prescribe them
in partnership with a medical practitioner (SP).
In August 2006, The Medicine and Healthcare Products Regulatory Agency
and the Department of Heath jointly consulted on the proposal to introduce
independent prescribing (IP) for optometrists [5]. In June 2007 the
Commission for Human Medicines proposed to restrict the scope of
optometrist independent prescribing by reference to the competence of the
individual prescribing optometrist [6], rather than linking it to an approved
formulary, as has been the case for entry-level and AS prescribing. The same
reference to competence has been taken with regard to Nurse and
Pharmacist Independent Prescribing.
1
Pilocarpine and Atropine are now available only to Optometrists with the
Additional Supply Qualification.
2
The Department of Health and the General Optical Council (GOC) have since
worked to achieve the necessary legislative changes [7]. Changes to the
POM Order came into effect in June 2008 [8] and the GOC launched the IP
Register on 1 November 2009.
The new legislation permits IP qualified optometrists to prescribe any licensed
medicine for ocular conditions affecting the eye and the tissues surrounding
the eye. In practice, however, IP optometrists will only work with conditions
within their area of recognised competence.
Registrants who wish to become independent prescribers are required to
complete further GOC-approved training and apply for entry of their specialty
in the register.
Training
The additional independent prescriber training requires the completion of
theory modules, a period of clinical placement, under the supervision of a
designated ophthalmologist, and a final examination.
There are currently three providers which offer the theoretical part of the
training; Glasgow Caledonian University, City University in London and a
course run jointly by Manchester and Aston Universities [9]. All three courses
are GOC approved and cover the syllabus set out by the GOC [10] for
therapeutically prescribing specialty. Details about the delivery of the syllabus
differ between institutions but all have adopted a flexible learning approach,
underpinned by directed distance learning. As an example, the course
offered by Glasgow Caledonian University is divided into three modules, each
worth 20 post-graduate points. Each module is predominantly part-time
distance learning, supplemented by two days of lectures and practical
workshops at the University. The distance-learning component comprises a
series of articles (e.g. basic principles of therapeutics, anti-infective and antiinflammatory drugs for ophthalmic use, immunology and allergies,
microbiology, wide range of ophthalmic conditions) and access to Internet
based discussion groups and self-assessment. Lecture topics have been
chosen to supplement and support the course literature and include
conjunctivitis & blepharitis, superficial injury, uveitis, scleritis, keratitis, dry eye,
glaucoma, and common systemic conditions and their medications. Practical
workshops include gonioscopy, application and removal of punctal plugs,
syringing the canaliculi, ocular first aid (including foreign body removal) and
glaucoma management. Each module can be completed in 3-4 months and
requires the submission of case records and passing a written exam.
Following the completion of the theoretical modules, trainees embark on a
period of practice-based training. The primary purpose of this component of
the training programme is to develop competency in the practice of
prescribing and to facilitate the integration of prescribing theory and practice
with the conditions that will be managed therapeutically. This training will
typically take place in the Hospital Eye Service under the supervision of a
3
designated ophthalmologist. For Independent Prescribing, the clinical
placement requires a minimum of 12 days (24 sessions of not less than 3
hours).
At the conclusion of the clinical placement, trainees sit a Common Final
Assessment (CFA) administered by the College of Optometrists. The CFA for
Independent Prescribing involves the submission of a logbook of Hospital
experience and a computer-based exam which covers patient-based
scenarios (75 multiple-choice questions in 90 minutes). The CFA is currently
run twice a year. Further information about the CFA can be found on the
College of Optometrist’s web page [11]. Following completion of the CFA, the
successful candidate will be awarded IP status and be allowed to register on
the specialist GOC list. Once registered, optometrists are required to keep
their skills up-to-date, audit their activity and comply with the additional CET
requirement for specialist optometrists.
Aim
Because the legislation, training and guidance underpinning therapeutic
prescribing for optometrists is very recent, the role of a prescribing optometrist
in the context of the NHS is not established. Given the dynamic nature of
these developments, this process will take time to evolve. The precise roles
that therapeutic optometrists take on will depend on their expertise,
confidence and the environment in which they work. It is clear that this role
will, to some extent, depend on the individual: it is likely that hospital
optometrists will take on different responsibilities from those based in
community practices. It would be informative at this early stage to gain insight
from IP optometrists, who have already qualified, about how they use their
therapeutic qualification. Knowing what IP practitioners do at present will
inform others undergoing training as well as those considering this option but
it might also aid the development of a professional role description. Hence,
the aim of this study was to collate information about the impact of the
therapeutic qualification on every day practice from therapeutically qualified
optometrists via a survey. Practitioners were asked questions which focussed
on their perception of the training, the confidence gained by it, the conditions
that they treat and which drugs they use, how often they prescribe and the
general impact of their prescribing activity for their patients, their practice and
the wider community (GPs, pharmacists, HES).
Methods
A questionnaire was developed (see appendix). The questionnaire was
initially drafted by two of the authors and then reviewed by a focus group
consisting of five optometrists; one IP optometrist, one who has completed the
theoretical training and clinical placement and is awaiting the CFA exam, one
who has completed parts of the theoretical training and two who are involved
4
in the delivery of the theoretical training. The revised version was then
piloted. The questions were provided online via ‘survey monkey’ – a webbased tool which permits users to create online surveys (www.surveymonkey.com). All practitioners who had successfully completed
the CFA with the College of Optometrists were invited to complete the
questionnaire. In addition, all optometrists who had completed the theoretical
training at GCU were invited to participate. These included optometrists who
were already AS or IP qualified as well as some that had not yet completed
their clinical placement. The survey could be completed in about 5 minutes
and was anonymous. Not all questions were available to all participants
depending on the stage of their training.
Results
Demographics & Qualification
Sixty optometrists participated in the survey. All participants had completed
their theoretical, University-based training. Sixty-two percent of participants
are working in Scotland, 35% in England and 3% in Wales.
Forty-seven of the participants had completed the clinical placement; 39 had
passed the CFA and were registered with the GOC as therapeutic prescribing
specialists. All but one of the 39 who had passed the CFA (n=38) were
qualified as IP optometrists (Fig. 1 A). As of February 2011 there are 62 IP
optometrists (43 in England, 1 in Wales, 17 in Scotland, 0 in Northern Ireland
and 1 overseas) and 33 AS optometrists (29, 1, 0, 1, 2) in the UK [12]. The
survey therefore sampled 61% of all currently registered IPs. Of those
qualified as IP, the majority (19 out of 38) are practicing in England, 17 in
Scotland and 2 in Wales.
Thirty-two (53%) of the optometrists work exclusively within the community,
20% in hospitals and 27% work in both. The distribution of the year
optometrists first registered with the GOC is essentially uniform (Fig. 1 B).
The likelihood of optometrists to undertake therapeutic training appears to be
largely independent of the year in which they first qualified.
5
Fig 1: Demographics and Qualification. A: The majority of participants are
qualified as IP (63%), one is qualified as AS; 35% are not yet registered as
therapeutic prescribing specialists but have completed the University based
training. Those qualified as IP represent 61% of all currently registered IPs in
the UK. B: The relationship between the year of qualification and the
numbers undertaking therapeutic training.
University training
The majority of survey respondents underwent their training at Glasgow
Caledonian University (78%), the remainder in London. Three quarters rated
the theoretical training 8, 9 or 10 on a scale from 1 (not helpful) to 10
(essential to prepare for IP prescribing), with a mean of 8.4 and a median of 9
(Fig. 2 A).
6
Fig 2: Perception of various components of the therapeutic training. All parts
of the training are rated high. A: Theoretical, University-based training. Three
quarters rated the theoretical training 8, 9 or 10 on a scale from 1 (not helpful)
to 10 (essential to prepare for IP prescribing), with a mean of 8.4 and a
median of 9. B: Clinical placement. The majority rated the clinical placement
as ‘essential to prepare for IP prescribing” (1 = not helpful and/or relevant; 10
= essential to prepare for IP prescribing). C: College exam (CFA). The
7
distribution of responses peaks between 6 and 7 (1=not assessing relevant
skills; 10=best way to assess skills and knowledge required from an AS/IP
optometrists) with an average of 6.9. D: General impact of IP training on
practice. Seventy-five percent see the training as very helpful for their
practice, rating it at 8 and above on a scale from 1 ‘not helpful, work in
practice has not changed as a result of training’ to 10 ‘very helpful, skills and
knowledge gained have a significant impact on everyday practice’.
Clinical Placement
Forty-seven optometrists had completed their clinical placement, 10 were
currently undertaking it and 3 had not yet started, this latter group indicating
that difficulty finding a hospital placement had prevented them from
commencing the placement.
During their clinical placements, optometrists attended clinics that are relevant
for their intended area of prescribing. The most popular clinics to attend for
training were glaucoma, A & E and General and Primary Care Ophthalmology
(Fig. 3 A). A significant number attended retinal and macula clinics, even
though IP optometrists are not permitted at present to administer injections for
wet macula degeneration or diabetic macula oedema.
8
Fig 3: Clinical placement. A: Clinics attended. The most popular clinics to
attend for training were Glaucoma, A & E and General and Primary Care
Ophthalmology. B: Time taken to complete training. Most optometrists
completed the 12 required days for IP within 3 months. Nearly all completed it
in 6 months or less. C: Length of placement. More than two-thirds consider
the required 12 days for IP as adequate. D: Number of patient episodes. The
range and number of conditions seen during the placement was judged
sufficient (1 = insufficient; 10 = sufficient range and number of conditions). E:
Interactions with supervising ophthalmologist. Opportunity to discuss
management with the ophthalmologist was judged sufficient to extensive (1 =
insufficient; 10 = extensive).
Most optometrists completed the 12 required days (24 sessions) in the
hospital within a 3-month period (Fig. 3 B). All but 5 completed their
placement in 6 months or less, but 4 required more than a year. More than
two-thirds consider the current placement requirement of 12 days adequate
(Fig. 3C). Most optometrists felt that they saw a sufficient number of
conditions during their placement (Fig. 3 D) and had sufficient time to discuss
management with the supervising ophthalmologist (Fig. 3 E). Overall, the
9
majority of respondents judged the clinical placement to be essential in
preparing for IP (Fig. 2 B).
College IP exam
The Common Final Assessment (CFA) for Specialist Qualifications in
Therapeutics received an average rating of 6.9 (1=not assessing relevant
skills; 10=best way to assess skills and knowledge required from an AS/IP
optometrists; Fig. 2 C).
Outcomes of Therapeutic training
The great majority of IP optometrists practice (or plan to) in the fields of
primary eye care or glaucoma. Just over half have are specialised in both
and only a few manage conditions in additional areas (Fig. 4 A).
75% reported that they have received feedback with regards to their
therapeutic management from patients, GPs, pharmacists and
ophthalmologists following qualification in specialist therapeutic prescribing.
The majority of reported feedback (83%) has been positive or very positive
(Fig. 4 B and C).
10
Fig 4: Impact of prescribing. A: Areas of specialty. The vast majority of IP
optometrists practice (or plan to) in the fields of primary eye care or glaucoma.
Just over half have are specialised in both. Other areas are comparatively
uncommon (see inset for a list). B & C: Feedback. 75% of optometrists have
received feedback with regards to their therapeutic management from
patients, GPs, pharmacists and ophthalmologists and the majority of this
feedback was positive or very positive.
Managed conditions
In an attempt to ascertain any potential benefit of the training independent of
the possibility to prescribe drugs, practitioners were asked if they now treat or
manage conditions after the training, which do not require AS/IP drugs but
which they did not manage before. Forty percent reported that this was the
case.
Table 1 summarises the most frequent conditions that optometrists stated
they manage after the training that they could have managed before.
Conditions (not requiring AS/IP) managed after training
Dry eye (including severe cases)
Epiphora
Lash removal
Tear duct syringe
Blepharitis
Meibomian gland dysfunction
Chalazion
Bacterial and viral conjunctivitis
SAC/PAC, allergic eye disease
GPC
Episcleritis
Foreign body removal
Corneal abrasion (including recurrent), trauma, epithelial defects
Marginal ulcers
Table 1: The most frequent conditions that optometrists stated they manage
after the training that they could have managed before.
Regarding therapeutic management that requires medications only available
to AS and IP optometrists, all but one of the 39 therapeutically qualified
optometrists (97%) indicated that they treat/manage conditions with AS/IP
medications. When asked to indicate which conditions they treat and what
drugs they use, the combined response showed a wide range of conditions
including blepharitis, allergic eye disease, a variety of corneal problems
(including herpes simplex keratitis), uveitis and glaucoma and using an
extensive range of ophthalmic drugs. A number of responses indicated the
use of topical steroids. Systemic medications are generally absent from the
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list, with the exception of treatment for severe blepharitis. Table 2 lists the
conditions and medications that therapeutically qualified optometrists currently
use. The data suggest that in some cases ocular disease management is
falling outside the recommendations within College of Optometrists Clinical
Management Guidelines [13]. Whilst this is possible (and indeed likely) within
designated local protocols or within the HES it should be mentioned that it
might not be appropriate for optometrists practising outside of these situations
Conditions managed with AS/IP qualification
Category
Dry Eye
Condition
Medication
Lids+Lashes:
Blepharitis & Chronic
Severe Blepharitis
Fusidic acid
Conjunctiva
Allergic eye disease
Mast cell stabilisers & anti
histamine; Nedocromil Sodium
(Rapitil); Olopatadine (Opatanol)
Ketorolac trometamol (Acular)
SAC, PAC, AKC, VKC
Viral conjuctivitis
Adult inclusion
Conjunctivitis
Angular conjuctivitis
Cornea
Uveitis/Scleritis
FB removal
Filamentary keratitis
Marginal keratitis
Marginal ulcers:
Corneal ulcers/contact
lens- related corneal
ulcer
Antibiotics for infection
bacterial keratitis
(small, off axis)
Herpes Simplex
Keratitis
Abrasions
Corneal graft
Episcleritis
Anterior uveitis:
Uveitis
Chloramphenicol, steroids
Ofloxacin (Exocin)
mainly Ofloxacin
anti viral, Aciclovir (Zovirax eye
ointment)
Steroids: Dexamethosone 0.1%
and Neomycin (Maxitrol)
Cyclopentolate; pred forte
Steroids: mainly
12
Dexamethosone 0.1%(Maxidex)/
Betamethasone (Betnesol)
Refraction
Atropine
Glaucoma
Drugs used include:
prostaglandin analogues, CAIs
(carbonic anhydrase inhibitors),
beta-blockers, pilocarpine, alpha
agonists.
Timoptol, Xalatan Azopt Trusopt,
Alphagan, Lumigan, Saflutan,
Diamox and combination drugs
such as Xalacom, Duo Trav,
Ganfort, Combigan, Cosopt,
Cosopt Preservative free &
Azarga
Post-operatively Cataract
Maxitrol, Betnesol –N, Betnesol,
Maxidex/ Prednisolone 0.5%
0.5% minims, Dexamethasone
0.1% minims, Predforte, Acular
Table 2: Conditions that therapeutically qualified optometrists manage.
Abbreviations: seasonal allergic conjunctivitis (SAC), perennial allergic
conjunctivitis (PAC), atopic keratoconjunctivitis (AKC), vernal
keratoconjunctivitis (VKC), foreign body (FB).
Prescribing
Most therapeutically qualified optometrists (87%) prescribe on a daily or
weekly basis (Fig. 5 B). Half of the 36 respondents have access to a
prescription pad (10 of those use it exclusively), the remainder rely on GPs,
ophthalmologists or patients to buy their medications (Fig. 5 C). The average
number of prescriptions issued is 18 per month with a median of 10.
According to this estimate, optometrists issue a prescription approximately
once every two days.
13
Fig 5: Prescribing activities and referrals. A: Impact of prescribing on
referrals. Onward referral rates have decreased for more than half of the 39
therapeutically qualified optometrists. B & D: Frequency and number of
prescriptions. Most therapeutically qualified optometrists prescribe on a daily
or weekly basis. The median number of prescriptions issued per months is
10. C: Way of prescribing. Half of the 36 respondents have access to a
prescription pad (10 of those use it exclusively), the remainder rely on GPs,
ophthalmologists or patients to buy their medications.
Wider impact
Ninety-two percent of optometrists feel more confident with diagnosis and
management as a result of the therapeutic training. Seventy-five percent
regard the training as very helpful for their practice (rating of 8 and above on a
scale from 1 ‘not helpful, work in practice has not changed as a result of
training’ to 10 ‘very helpful, skills and knowledge gained have a significant
impact on everyday practice’; Fig. 2D) and the overwhelming majority (93%)
would recommend IP training to a colleague.
Onward referral rates are reported to have decreased for more than half of the
39 therapeutically qualified optometrists. Referrals have remained the same
for 41% but a minority of 8% refer more often (Fig. 5 A).
14
Discussion
This survey shows a very positive perception of the training and practice for
prescribing optometrists. Both aspects of the training, the theoretical
component as well as the practical placement, are rated highly. Optometrists
are satisfied that the training provides improved theoretical and practical
knowledge for therapeutic management of a wide range of eye conditions.
The survey was deliberately restricted to those who have at least completed
the University training and the majority of the participants are qualified as
therapeutic prescribers. This allows a view on various aspects of the training
and the resultant practical implications. Many more optometrists will become
AS and IP in the next few years. In Scotland alone, more than 250
optometrists have started GCU’s course since 2009 and almost 100 have
completed it. This corresponds to approximately 20% of all optometrists in
Scotland.
Prescription pads are an essential feature of prescribing. Not only do they
allow patients easy and often cheaper access to medications, they allow
Health Boards in Scotland and Northern Ireland and Primary Care Trusts in
England and Wales to audit the prescribing activities including, for example,
whether the prescriber is prescribing to the local formulary. Prescribing via
the GP may be an acceptable route for local hospital eye departments but it
could be a problem if GPs do not accept the requests of an optometrist for a
prescription. According to our survey, at the moment 70% were reliant on
others (GPs, ophthalmologists) for at least some of their prescriptions.
An essential aspect of IP delivered by optometrists is the impact on health
care. This is difficult to determine not least because different aspects (e.g.
patient satisfaction and cost savings) would have to be weighted against each
other. It can be seen from our data that in total there are fewer onward
referrals after training than before. The number of prescriptions issued might
provide an indirect estimate of impact of IP. On the assumption that most of
these patients were treated successfully and did not require subsequent
referral, prescription numbers should correlate with ease of access for
patients and reduced costs for the NHS: non-prescribing optometrists would
have referred these patients for diagnosis and management, a process which
would have incurred additional costs. Nevertheless, without a careful audit,
this indirect assessment of the impact of IP on health care remains
speculative and there is a clear need for future studies to quantify the impact
of IP optometry on NHS costs and care.
One of the concerns expressed before the IP legislation was that optometrists
would not get enough experience [5]. Our study found that 42% of
prescribers write 1-10 prescriptions a month with a median of 10. Most of our
sample prescribes on a daily or weekly basis. It remains to be seen if this is
sufficient to maintain competence.
All IP optometrists must state the number of prescribing events in their annual
registration with the General Optical Council. The purpose of this is to provide
15
a safety net and prevent the public being exposed to an optometrist who is
prescribing only very infrequently. It is of some concern that 32% did not
report auditing their prescribing, as this is a GOC requirement. Audit enables
the optometrist to measure and reflect on their IP practice. It is an essential
part of NHS practice [4] and is recommended in the College’s ‘Advice and
Guidelines for Optometrist Prescribers’[14] . Recent experience shows that
evidence from audit can be used both to implement local protocols (e.g.
Glasgow Integrated Eyecare Service) and lobby for governmental changes to
regulations [15].
Positive feedback, especially from patients, is critical to the future success of
IP and it was encouraging to see that the majority of feedback received was
positive or very positive and that this feedback was coming from GPs and
ophthalmologists as well as patients. This may be an area for future
research, especially with respect to examining the awareness within the
general public of the existence of this service.
The average time taken to complete the practical placement was 4 months.
Adding the time to complete the theoretical part (a minimum of 10 months in
the case of GCU) and about 2 months to apply and prepare for the College
CFA exam, gives a total of 16 months. Hence, optometrists can acquire IP
registration in about a year and a half.
The speciality is still very much in its infancy. The first IP optometrists
qualified only 18 months prior to our survey, in November 2009 and less than
1% of the profession are on the specialist therapeutic prescribing register at
the time of writing. Although the opinions expressed in this survey represent
more than 60% of all currently registered IP optometrists, this nevertheless
means that the actual number of participants is small. The purpose of this
survey was not to ascertain the view of the profession as a whole towards
therapeutic prescribing (see [16, 17] for the viewpoint of a wider sample of
optometrists). Instead, the aim was to learn what those optometrists, who
have completed the theoretical training, think about the training and what
impact it has had on their practice. This article is therefore restricted to
providing an initial perspective. A subsequent review in a few years time will
be indicated to provide a description of how prescribing for optometrists has
established itself. We hope that a description of the initial stages has the
potential to help shape that establishment by informing the wider profession
and those already registered as IP optometrists about the experience of the
early prescribers. This should be of interest to those who are already
qualified (to draw comparisons with their peers), to those who are considering
undertaking therapeutic training but also to the broader optometric
community. The development, scope and practical implementations of IP
Optometry may also interest members of other health care professions.
Notwithstanding the new development, the practitioners sampled in this
survey are using their newly gained prescribing rights to manage a wide range
of conditions with an extensive range of medications.
16
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Needle, J.J., R. Petchey, and J.G. Lawrenson, A survey of the scope of
therapeutic practice by UK optometrists and their attitudes to an extended
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prescribing role. Ophthalmic & physiological optics : the journal of the British
College of Ophthalmic Opticians, 2008. 28(3): p. 193-203.
Acknowledgements
We would like to thank Dr Mhairi Day for her help in designing the
questionnaire and providing invaluable feedback on this document.
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Appendix A – Training Questionnaire
About You
1. In which country do you practice? (Tick one)
Scotland / England / Wales / Northern Ireland / Other (please
specify)
2. In which year did you first register with the GOC?
3. Where do you work? (Tick all that apply)
In the community / In a hospital / Other (please specify)
AS/IP Training - University Based (Theoretical)
1. At which University did you take your AS/IP training? (Tick one)
Glasgow / London / Manchester / Other (please specify)
2. How would you rate the University training?
(Scale: 1 = not helpful and/or relevant; 10 = essential to prepare
for IP prescribing)
AS/IP Training - Clinical Placement
1. At what stage is your Clinical Placement? (Tick one)
Not Started / In-Progress / Complete
AS/IP Training - Clinical Placement (Not started)
1. What is preventing the start of your clinical placement?
No time / Not possible to get placement / Other (please specify)
AS/IP Training - Clinical Placement (In progress)
1. Where (e.g. which hospital) are you doing your clinical placement?
2. Do you feel you will examine a sufficient number of patients with
relevant clinical conditions?
(Scale: 1 = insufficient; 10 = sufficient range and number of
conditions)
2. Which clinics do you attend? (Tick all that apply)
None / A+E / Glaucoma / Retina / General Ophthalmology / Macula /
Vitreoretinal / Uveitis / Other (please specify)
3. When do you expect to complete your placement? (Tick one)
Within next month / Within next 3 months / Within next 6 months /
Within 1 year / Other (please specify)
4. What do you feel about the duration of the clinical placement?
(Tick one)
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Too short / Just right / Too long
6. How would you rate the Clinical placement?
(Scale: 1 = not helpful and/or relevant; 10 = essential to prepare
for IP prescribing)
AS/IP Training - Clinical Placement (Complete)
1. In which hospital was your clinical placement?
2. Did you feel you examined a sufficient number of patients with
relevant clinical conditions?
(Scale: 1 = insufficient; 10 = sufficient range and number of
conditions)
2. Which clinics did you attend? (Tick all that apply)
None / A+E / Glaucoma / Retina / General Ophthalmology / Macula /
Vitreoretinal / Uveitis / Other (please specify)
3. To what level did you discuss management of patients with the
supervising ophthalmologist?
(Scale: 1 = insufficient; 10 = extensive)
4. How long did it take to complete your placement? (Tick one)
1 month / 3 months / 6 months / 1 year / Other (please specify)
5. What did you feel about the duration of the clinical placement?
(Tick one)
Too short / Just right / Too long
7. How would you rate the Clinical placement?
(Scale: 1 = not helpful and/or relevant; 10 = essential to prepare
for IP prescribing)
AS/IP Training - Qualifications
1. Are you qualified as ... (Tick all that apply)
AS / SP / IP / Not yet qualified
AS/IP Training - College Exam
1. How would you rate the College exam?
(Scale: 1 = not assessing relevant skills; 10 = best way to assess
skills and knowledge required from an AS/SP/IP optom)
Feedback
1. Have you received any feedback from ... (Tick all that apply)
Patients / GPs / Pharmacists / Ophthalmologists / No feedback
received / Other (please specify)
2. Has feedback been:
Very positive / Positive / Ambivalent/mixed / Additional Comments
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Patient Management / Prescribing (Qualified)
1. As a result of the therapeutic training, do you feel more
confident with respect to diagnosis/management of your patients?
More confident / Less confident / About the same
2. Do you treat or manage conditions now that do not require AS/IP
drugs but which you did not manage before? (Tick one)
Yes* / No (* LIST CONDITIONS)
3. Do you refer patients more or less often than before?
More / Less / Same
4. In which conditions do you specialise or plan to specialise? (Tick
all that apply)
Primary Eye Care / Glaucoma / Other (please specify)
5. Do you treat/manage conditions that require AS and/or IP? (Tick
one)
Yes* / No (* LIST CONDITIONS AND THE DRUGS YOU USE)
Prescribing
1. How often do you prescribe? (Tick one)
Never / Daily / Weekly / Monthly / Less than monthly
2. How many prescriptions do you issue per month on average?
3. How do you prescribe? (Tick all that apply)
Prescription pad / Written order / via GP / via Ophthalmologist /
Other (please specify)
4. Do you audit your prescribing activities? (Tick one)
Yes / No (If 'Yes', please give details)
Patient Management / Prescribing (Not yet qualified)
1. Do you feel more confident with respect to diagnosis/management of
your patients?
More confident / Less confident / About the same
3. Do you treat or manage conditions now that do not require AS/IP
drugs but which you did not manage before? (Tick one)
Yes* / No (* LIST OF CONDITIONS)
4. Do you refer patients more or less often than before?
More / Less / Same
5. In which conditions do you specialise or plan to specialise? (Tick
all that apply)
Primary Eye Care / Glaucoma / Other (please specify)
AS/IP Training -It's Impact
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1. How helpful was the AS/IP training for your practice?
(Scale: 1 = not helpful, work in practice has not changed as a result
of training; 10 = very helpful, skills and knowledge gained have a
significant impact on everyday practice)
2. Would you recommend IP training to a colleague? (Tick one)
Yes / No / Maybe
3. What aspects of the IP training would you improve?
AS/IP -The Future
1. Do you expect to manage more conditions in the future? (Tick one)
Yes / No (If 'Yes', please list conditions and drugs)
2. What changes would you like to see in the future?
3. Where do you see the future of prescribing for therapeutically
qualified optometrists?
4. Please enter any additional comments you would like to make
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