Hans_Thorvald_Haugo_-_Experience_regarding_use_of_diagnostic_drugs_in_Norway

Experience regarding use of diagnostic drugs in Norway Hans Torvald Haugo, optometrist - MSc Secretary General and Professional Manager The Norwegian Association of Optometry and Optical Information Council

WCO defines optometry as follows:

“Optometry is a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.�

Getting new rights

Education Legislation

Regulation

Diagnostic drugs in Norway • First mentioned in our strategy 1998 – 2010 • Education started up 1998 (MSC-course, PCO) • Optometrists got rights using diagnostic drugs 1.th of May 2004

Optometry - healthcare • Optometrists in Norway today have a expanding role within primary eye care.

• The Norwegian health care system have enormous challenges in the future.

The role of the craftsman is less important than before.

But remember – it is not unimportant!

Challenges in the future

Just to your information…

• 5 million people • 1500 optometrists • 356 ophthalmologists • 40 orthoptists

• 5,5 million people • 2200 optometrists • 350 ophthalmologists • 20 orthoptists

Discussion about diagnostic drugs – always a discussion about safety

Figures in this lecture • Facts from 3 different studies:

– 2005 (69) – 2008 (395) – 2012 (214)

Age distribution Age 2012 3%0 13 %

28 %

Below 20 21 - 30

24 %

31 - 40 41 - 50

32 %

51 - 60 61 - 70

Sex

Education – highest level

2005: 93% w/ MSc 2008: 44% w/ MSc

Use of rights

Use of rights

Type of use

List of diagnostic drugs: Cycloplegic refraction (childeren) Atropin øyedråper 10 mg/ml «Ophtha» Atropin Minims øyedråper 10 mg/ml «Chauvin» Cyklopentolat Cyclopentolat Minims øyedråper 10 mg/ml «Chauvin» Homatropin Homatropin øyedråper 10 mg/ml «Ophtha» Miosis (pupil retraction) Isopto-Carpine øyedråper 20 mg/ml «Alcon» Pilo øyedråper 20 mg/ml «Novartis» Pilokarpin øyedråper 20 mg/ml «Ophtha» Pilokarpin Minims øyedråper 20 mg/ml «Chauvin» Large pupils (lens, vitreous, fundus) Tropikamid Minims øyedråper, endosebeholdere 5 mg/ml (0,5%) «Chauvin» Mydrian øyedråper 0,5% «Novartis»

Lokal anesthesia (different examinations) Oksybuprokain Oxibuprokain Minims øyedråper 4 mg/ml «Chauvin» Proksmetakain Alcaine øyedråper 5 mg/ml «Alcon» Tetrakain Tetrakain Minims øyedråper 10 mg/ml «Chauvin» Adrenalin EpiPen Jr injeksjonsvæske i autoinjektor 0.15mg/dose «ALK-Abello» (til bruk på barn) EpiPen injeksjonsvæske i autoinjektor 0.3 mg/dose «ALK-Abello» (til bruk på voksne)

Easy use starter kit:

Tetracaine

Cycloplentolate

Tropicamid:

Reversible local anesthesia

Mydriatic and cycloplegic agent

Short acting mydriasis and cycloplegia

Personal clinical advice:

Tetracaine Reversible local anesthesia

Change with Oksybuprokain -Stains less

Which drugs are in use?

No use of EpiPen!

Side effects or complications

Summary 2005: • • • •

Safer Change of respect from other professions Referrals from colleges Mostly just positive reactions from the patients • Side effects: almost 1/3 • Not only for diagnostic purposes – getting a better view/feeling safer

Summary 2012: • Use of diagnostic drugs improves the quality of the examination • Use of new techniques – development • Patients feel more safe • Some tell about less referrals • Gives the patient the confidence they deserve • Get more trust from patients • Better possibilities regarding examination choices

Put your head on the chopping block‌

Please remember two things about diagnostic drugs: Diagnostic drugs is not a right for optometrists, it’s for the patients best!

Safety first