Australian optometrists face “various funding, regulatory, technological, cultural, and inter-professional barriers” preventing them from practising to their fullest scope, Optometry Australia (OA) has told an independent review, while calling for a detailed comparison of health professionals in other countries to identify opportunities for further scope enhancements.
Representing around 6,700 optometrists, the peak body also highlighted examples of health systems where prescribing of oral medications and intravitreal injections – which Australian optometrists are prohibited from performing – are performing by non-ophthalmologists, and how one of the biggest hurdles is the scaling of collaborative care models already established in parts of the country.
The details are contained in OA’s submission to the ‘Unleashing the Potential of our Health Workforce’ independent review led by Australian National University health workforce expert Professor Mark Cormack.
The review will identify opportunities to remove the barriers stopping health professionals working to their full scope-of-practice. It will also look for examples of multi-disciplinary teams working at the top of their scope to deliver best practice primary care.
OA strongly supports the process, which it said “is of vital interest to the optometrist profession”. However, in the past, calls to increase the optometry scope have failed to convince ophthalmology bodies like RANZCO and the Australian Society of Ophthalmologists (ASO) who both cite patient safety as key barriers to optometrists prescribing and administering oral and intravitreal therapies.
But in the submission, OA CEO Ms Skye Cappuccio said the optometry scope in Australia is more limited than in comparable countries like New Zealand, the UK, the US and Canada, including oral prescribing.
“[These] are noteworthy as they mean that Australian optometrists with equivalent qualifications that are duly recognised in New Zealand are unable to practise in Australia to the same scope as their counterparts across the Tasman,” she said.
“Optometrists face various funding, regulatory, technological, cultural, and inter-professional barriers to maximising the utilisation of their professional skills and qualifications. These barriers can prevent optometrists from providing comprehensive treatment and support to their patients and make it more difficult to work collaboratively with other health professionals managing chronic eye health conditions. Despite these hurdles, optometrists have demonstrated their willingness to embrace enhancements to their scope-of-practice and an ability to develop innovative models of collaborative care to address unmet eye health needs.”
One of the challenges for optometrists and their professional organisations like OA is the ability to scale successful collaborative care initiatives in the mainstream health system, OA said.
The organisation believed it was vital the review recommends meaningful changes that would benefit patient outcomes and the overall productivity of the health system long term. To do this effectively, OA is encouraging the review to focus on addressing “structural and systemic impediments”.
These include incompatibilities between the federal and state/territory health systems (and between the public and private systems) regarding funding and remuneration, regulatory requirements, clinical and organisational obligations, and the handling of patient data.
OA also highlighted discrepancies in the ability of various health professions to access MBS items despite performing the same clinical tasks; traditional patient gatekeeper arrangements and referral pathways that engrain treatment siloes and prevent timely care; disincentives to use the most cost-effective and accessible care options; and a lack of incentives to encourage health professionals to maximise available technologies to enhance access and enable multidisciplinary care.
Drawing on the optometry experience, Cappuccio said OA believed there would be value in undertaking a detailed comparison of the current scope-of-practice of individual health professions in Australia with similar overseas health systems, identifying possible scope enhancements that could benefit patients and the overall productivity of Australia’s health system.
In terms of lessons learned and areas of future opportunity, the review will consider innovative practices in rural and remote contexts.
“Optometry Australia strongly supports this element of the review,” OA stated. “In eye health, some of the most innovative approaches are in rural and remote locations, including the Pilbara in Western Australia, where optometrists and ophthalmologists have developed co-management models of care that are making a marked difference to the eye health of First Nations Peoples through a combination of practising to full scope and utilising digital technologies to enhance patient access and interprofessional collaboration.”
In response to OA’s submission, ASO president Dr Peter Sumich said the organisation always welcomed optometry co-management and assistance with disease screening. However, he said the ASO, RANZCO and Australian Medical Association remained “implacably opposed” to optometry scope increases that involve surgical entry into eyes such as intravitreal injections.
“In the US, the State Governor Gavin Newsome of California, banned optometrists from performing this invasive procedure. In other US states, despite there being greater laxity in safety regulations, it remains almost unheard of for optometrist injections to occur due to severe medicolegal risks,” he said.
“Despite the routine success of intravitreal injections, even in expert hands we see things go wrong sometimes. When it happens, it happens fast and severely and is challenging even for ophthalmic surgeons. It’s a numbers game – do enough and it will happen. It’s not an if, but a when. In those circumstances it would not be advisable to be without ophthalmic surgical expertise to recognise the issue, solve it and appear medicolegally sound.”