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Regulations a barrier to eyecare needs

13/04/2018
As healthcare professionals from regional Australia and the public health system are especially aware, it can be challenging to meet the demand for eyecare services in the community. The magnitude of this demand is projected to increase as our population ages.

Public health advocates have proposed extending the roles of allied health personnel in order to address this shortfall. Thus, there is potential for orthoptists to add to the efficiency and sustainability of our healthcare system.

While ophthalmologists are the most appropriate people to manage medical and surgical conditions of the eye, and our colleagues in optometry excel in providing primary eyecare and managing refractive errors, orthoptists can lead the way in ocular screening and monitoring of stable disease.

Additionally, orthoptists are particularly well trained in the diagnosis and treatment of certain paediatric eye disorders, most notably amblyopia.

However, the current drugs and poisons regulations have created a barrier to taking full advantage of the orthoptic workforce for the benefit of patients and taxpayers.

Under current regulations, in all states and territories orthoptists must only instil eye drops when practising under the direction of a registered medical practitioner or an authorised optometrist.

"The current drugs and poisons regulations vary greatly between states and territories across Australia, forming a disorganised patchwork of uncertainty"

Without changes to the current drugs and poisons regulations, our healthcare system cannot fully benefit from the training and expertise of orthoptists.

Until then, authorisation of pupil dilation and local anaesthesia continues to add to the administrative workload of medical practitioners and requires double handling of patients.

In order to obtain a Master of Orthoptics in Australia, the minimum standard for new graduates to gain Board certification, students are required to complete compulsory units on ocular pharmacology. Thus, orthoptists are qualified to safely administer ophthalmic preparations such as the local anaesthetics, cycloplegics and mydriatics that are required for diagnostic testing.

Australian allied health professionals currently eligible to use scheduled drugs include podiatrists, oral health therapists, optometrists, nurse practitioners and midwives. Therefore, regulating for the autonomous use of specified scheduled drugs by appropriately trained and accredited orthoptists would by no means set a precedent.

Across the UK, orthoptists with extended training have been successfully contributing to the provision of eyecare services since they were granted permission to administer medicines under exemptions from existing regulations.

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Both the Association of Optometrists and the Royal College of Ophthalmologists have supported these changes, as a way of mitigating the growing strain on the National Health Service and improving services to patients. Given the program’s success, the question must be asked; why have we not adopted a similar approach?

The current drugs and poisons regulations vary greatly between states and territories across Australia, forming a disorganised patchwork of uncertainty.

For example, in Queensland standing orders are permitted whereby pre-specified drug administration protocols can differ by workplace. However, some other state regulations list the drugs and conditions required for administration by orthoptists, while other state regulations fail to name orthoptists at all.

Nationalisation of drug and poisons regulations seems especially appropriate in relation to orthoptists, who graduate from only two training schools across Australia: University of Technology in Sydney and La Trobe University in Melbourne.

In previous discussions between representatives from the Victorian Branch of Orthoptics Australia and the Victorian Department of Health and Human Services, it was ascertained that considerable effort would be required in order for the department to consider legislating for changes to be made to the regulations.

As such, proposed amendments must be backed by substantial evidence that the changes will address a serious need in our community and that all measures will be taken to ensure risk minimisation.

I am confident that this evidence can be gathered, and would result in measurable improvements to eyecare delivery in Australia, for both patients and eyecare professionals.


Name: Myra McGuinness
Qualifications: MBiostat BOrth
Workplace: Bass Coast Eye Centre
Position: Orthoptist
Location: Wonthaggi VIC
Years in practice: 18

 

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