An analysis of glaucoma repeat measures assessment results: Are core competencies enough?

PURPOSE: The need to validate core competency skills in qualified optometrists wishing to take part in extended roles in glaucoma care has been questioned. This analysis examines the ability of qualified optometrists to perform relevant core competency skills under standardised objective assessment conditions to explore whether such validation is justified. It also investigates if there are associations between performance, gender and length of time since qualification. METHODS: Anonymised data from the Cardiff University assessment programme for the Wales Optometry Postgraduate Education Centre (WOPEC) Local Optical Committee Support Unit glaucoma referral filtering and monitoring pathway delivered between January 2017 and March 2020 were analysed. Results were combined with demographic data from the General Optical Council register of optometrists in the UK to investigate associations between performance and practitioner characteristics, namely length of time since qualification and gender. RESULTS: The assessment results of 2215 optometrists practising in England (approximately 15% of all UK registered optometrists and 30% of all optometrists registered in England) were analysed. Failure rates for first time assessment in each of five objective structured clinical examination style practical assessments were 8.5% (van Herick); 8.8% (slit lamp binocular indirect ophthalmoscopy); 10.1% (Goldmann applanation tonometry calibration); 21.9% (Goldmann applanation tonometry) and 23.3% (case scenario interpretation and management). There were either no associations or at most very weak associations between performance and practitioner characteristics. CONCLUSIONS: Our results suggest that these competencies are not universally present in optometrists practising in England and that ongoing training and assessment of these competencies is justified for entry into extended roles. There are no meaningful associations between performance in these assessments and gender or time since qualification.

Referral thresholds for an integrated learning disability eye care pathway: a consensus approach.

INTRODUCTION: Local Optometric Support Unit (LOCSU) have published their refreshed clinical pathway for eye care for people with a learning disability. The document sets out the adjustments to practice that a community optometrist might make in order to provide optimal care for a person with learning disability attending a primary eye care assessment. The pathway specifically points to the need to retain patients in primary care where appropriate and 'reduce the number of people with learning disability who are inappropriately referred into the Hospital Eye Service (HES).' Pivotal to this refreshed pathway is the integration with secondary care, with local arrangements to facilitate referral and hospital management where appropriate. There are few ophthalmologists nationally who frequently encounter patients with a learning disability in their hospital practice and knowing where to start when creating referral criteria or KPIs may create a barrier to services becoming established. In order to address this gap in experience, we set about developing a set of consensus statements regarding referral thresholds for ocular conditions commonly encountered in adults with learning disability. METHOD: A series of video interviews were undertaken with eye health professionals with a range of experience in eye care for people with learning disability. Each contributor commented on the usability and clarity of each element of the referral criteria. In addition, each contributor was asked to express the overriding principles by which they make decisions regarding referral thresholds for patients with learning disability. These were collated into the final document which was circulated and agreed by all participants. RESULTS: A table setting out referral thresholds for commonly encountered eye conditions in adults with learning disabilities is presented. CONCLUSION: We have presented a succinct set of consensus statements relating referral thresholds for common presentations of visual problems in adults with learning disability in the UK distilled from the collective experience of a group of eye health professionals. The intention was not to present a comprehensive review of management of each condition. Rather, the consensus statements may form the starting point from which each area could develop locally agreed criteria, as is suggested by the LOCSU pathway guidance.

Continuing professional development requirements for UK health professionals: a scoping review.

OBJECTIVES: This paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals is described internationally to characterise the postqualification training required of UK professions by their regulators. It compares these standards across the professions and considers them against the best practice evidence and current definitions of CPD. DESIGN: A scoping review. SEARCH STRATEGY: We conducted a search of UK health and social care regulators' websites to establish a list of regulated professional titles, obtain numbers of registrants and identify documents detailing CPD policy. We searched Applied Social Sciences Index and Abstracs (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, EMCare and Scopus Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities databases to identify a list of common features used to describe CPD systems internationally and these were used to organise the review of CPD requirements for each profession. RESULTS: CPD is now mandatory for the approximately 1.5 million individuals registered to work under 32 regulated titles in the UK. Eight of the nine regulators do not mandate modes of CPD and there is little requirement to conduct interprofessional CPD. Overall 81% of those registered are required to engage in some form of reflection on their learning but only 35% are required to use a personal development plan while 26% have no requirement to engage in peer-to-peer learning. CONCLUSIONS: Our review highlights the wide variation in the required characteristics of CPD being undertaken by UK health professionals and raises the possibility that CPD schemes are not fully incorporating the best practice.

Findings from an opt-in eye examination service in English special schools. Is vision screening effective for this population?

Our objective was to present the findings of an opt-in, school-based eye care service for children attending 11 special schools in England and use these findings to determine whether a vision screening programme would be appropriate for this population. Data from eye examinations provided to 949 pupils (mean age 10.7 years) was analysed to determine the prevalence and aetiology of visual deficiencies and reported eye care history. For 46.2% (n = 438) of pupils, a visual deficiency was recorded. 12.5% of all the children seen (n = 119) had a visual deficiency that was previously undiagnosed. Referral for a medical opinion was made for 3.1% (n = 29) of pupils seen by the service. Spectacle correction was needed for 31.5% (n = 299) of pupils; for 12.9% (122) these were prescribed for the first time. 3.7% (n = 11) of parents/carers of pupils needing spectacles chose not to use the spectacle dispensing service offered in school. Eye care history was available for 847 pupils (89.3%). Of the pupils for whom an eye care history was available, 44% (n = 373) reported no history of any previous eye care and10.7% (n = 91) reported a history of attending a community optical practice/opticians. Only one pupil from the school entry 4-5 age group (0.6% of age group n = 156) would have passed vision screening using current Public Health England screening guidelines. Children with a diagnosis of autism were significantly less likely to be able to provide a reliable measurement of visual acuity. This study supports previously published evidence of a very high prevalence of visual problems in children with the most complex needs and a significant unmet need in this group. It demonstrates routine school entry vision screening using current Public Health England guidelines is not appropriate for this group of children and very low uptake of community primary eye care services.

Paediatric community vision screening with combined optometric and orthoptic care: a 64-month review.

We report a new model of community-based secondary vision screening and demonstrate that a high proportion of children can be effectively managed in such a clinic without referral to the hospital eye service (HES). We performed a 64-month retrospective study of a secondary vision screening clinic providing the combined skills of an optometrist and orthoptist in a community setting. Particular attention was given to the diagnosis and management of children not referred to the HES. During this period, 1755 children were sent appointments and 74% (1300) attended the clinic. The community orthoptist and school nurses referred 53% of the patients and health visitors, general practitioners and community medical officers made 32% of the clinic referrals. Spectacles were prescribed for 41% of the children and 8% were prescribed patching. Sixteen per cent of the children were referred on to the HES. This model of care using the combined expertise of the orthoptist and optometrist is able to diagnose and manage the majority of children who have failed primary vision screening and avoids unnecessary referrals to the HES.