Vision Health
(Globe & Mail insert)
How all of Canada can learn from a Nova Scotia initiative
Ophthalmologists, optometrists and family doctors have come together in Nova Scotia and devised a model for eye care that proponents believe has transformed diagnosis and treatment in the province.
"Only 15 per cent of diabetics were getting routine eye care before," says Dr. David Dobbelsteyn, an optometrist with the Nova Scotia Eye Care Working Group in Halifax. "Now, the number is probably 50 per cent."
That dramatic change, accomplished with lessened waiting times and reduced public expense, flows from a simple premise that has taken years of hard work to implement: Family doctors and optometrists can play a significant role in diagnosing and following certain eye conditions, creating more patient access to care and better using the time of the limited numbers of ophthalmologists.
Developed by the Eye Care Working Group, this initiative called the Comprehensive Vision Care Program uses models for referrals that have had impressive buy-in across the several professional communities involved, not least because all participated in their creation.
"The general practitioner is the centre of the wheel, sending patients on to the optometrist who then sends them on, if necessary, to the ophthalmologist," explains Dr. Dobbelsteyn of the Coalition.
This means earlier diagnosis and a rational progression to increasingly specialized care as needed.
Dr. Raymond LeBlanc, chair of the National Coalition for Vision Health and chief of ophthalmology at Dalhousie University in Halifax, remarks of the Nova Scotia model that "we've always insisted that it be a patient-centre process."
In his submission to the recent Romanow Commission on health care, Dr. LeBlanc noted that the Nova Scotia group "has developed algorithms to guide the family doctor and optometrist in his or her decisions about when and where to refer persons with diabetes, patients with diabetic retinopathy and patients with red eye. These models acknowledge that family doctors and optometrists are, by training and experience, capable and appropriate to manage many aspects of diabetes, diabetic retinopathy and red eye."
With deliberations dating to 1994, the effort was hardly accomplished overnight. Changes to the Nova Scotia Optometry and Pharmacy Acts were required to allow optometrists to prescribe certain antibiotics, for example, and for billing codes to be adjusted to reflect these professionals' expanded role. Not least, all involved practitioners were invited to participate in the ongoing discussions.
While the Comprehensive Vision Care Program is still only active in the one relatively small province, Dr. LeBlanc told the Romanow Commission that "the model can be easily adapted to reflect the geographic, demographic and cultural realities of any given province or territory."
There will still be some political realities to overcome, however. Despite being greatly overloaded by patient demand, not all ophthalmologists are ready to cede so much of primary eye care to optometrists, who are vision professionals but not physicians.
But training in optometry has already expanded considerably in the past two decades, and creating new models of care will further influence the training background of the involved professionals.
"If you work co-operatively on a model," Dr. LeBlanc notes, "you get an opportunity to help mould the scope of practice of everybody in the model. And we do have good training for optometry in Canada."
As it happens, there's no longer much debate in Nova Scotia that the model has improved access to eye care considerably.
"Everybody involved with the program," reports Dr. Dobbelsteyn, "knows and says it's the best model for patient care.
