Geographic availability to optometry services across Canada: mapping distribution, need and self-reported use

Optometrists who leave the profession in Australia: 2011 to 2019

CLINICAL RELEVANCE

The number, demographics, registration status and geographic distribution of optometrists in Australia who do not renew their registration is reported.

BACKGROUND

The size of the optometry workforce in Australia is determined by the number of new entrants to the profession and the number of optometrists leaving it. Limited attention has been paid to the latter.

METHODS

A dataset obtained from the Australian Health Practitioner Registration Agency about registered optometrists during the period 1 January 2011 to 31 December 2019 was analysed. It included registrants' first year of registration, gender, year of birth (in five-year bands), optometry qualification; and annual collection of registration type and postcode of principal place of practice.

RESULTS

Data for 6,595 registrants were analysed. Over the study period, 626 optometrists left the register. When those leaving the register were examined by year of birth bands, two main groups emerged - optometrists aged in their fifties or older, and optometrists who were under forty years of age and disproportionately male. Registration type had a significant effect on whether a registrant left or remained on the register (p < 0.05). Those holding Non-practising Registration or Limited Registration were more likely to leave the register. Registrants with an optometry qualification from an overseas institution, including from New Zealand, were more likely to leave the register (p < 0.05). Optometrists whose registration was not endorsed were more likely to leave the register (p < 0.05). No significant difference was found when the geographic location of optometrists who left the register was compared with those who remained.

CONCLUSION

Optometrists who left the register fell into two main groups - late-career and early-career. An unanticipated finding was that younger optometrists who left the register were disproportionately male. What motivates optometrists in Australia to leave the register is worthy of future research.

Financial Inequities in Optometric Education in Canada: A Comparison of Two Optometry Programs

SIGNIFICANCE

The advancing age of the population will require increased access to eye care services to manage eye diseases and vision correction. Optometric education requires a sound financial plan to manage student debt. This study evaluates the financial inequalities of optometric programs in Canada and how this may impact the provision of eye care professionals.

PURPOSE

The objective of this study was to compare the financial inequities in optometric education in Canada from the 2020 graduating class.

METHODS

A cross-sectional study assessed monetary variables related to the study of optometry in Canada, including academic and personal expenses, and overall debt and expenses related to the COVID-19 lockdown for the 2020 graduating class.

RESULTS

A total of 108 optometry students from the 2020 graduating classes of the University of Montreal and the University of Waterloo responded, with 68 (female/male respondents, 53:15; mean [standard deviation] age, 25.66 [2.01] years) completing the study. Waterloo students spent more years in university ( P < .001), had higher academic fees ( P < .001), spent more on traveling to their family residence ( P = .007), and received more provincial ( P = .002) and federal ( P < .001) loans than Montreal students. Overall debt before optometry was similar among students but differed ( P < .001) at the end of their program, with Waterloo students having a higher debt burden.

CONCLUSIONS

There is a financial inequity in optometric education in Canada depending on the chosen program. Cumulative optometry student debt for the 2020 graduating class in Canada ranges from Can $0 to $189,000 with an average of Can $65,800 and a median of Can $50,000. The results of this study can assist financial and government agencies, and future optometry students to better understand the financial burdens and establish a financial plan to study optometry in Canada, to respond to the growing eye care needs of the public.

Scope of optometry practice in Trinidad and Tobago: A cross-sectional study

Background and Aim

To report the scope of optometry practice in Trinidad and Tobago to identify areas that need improvement.

Methods

A cross-sectional study of optometrists in Trinidad and Tobago was conducted using a validated self-structured questionnaire. Data obtained was exported to the Statistical Package for Social Sciences. Descriptive analysis and Pearson χ 2 were used to summarize the demographic data and determine associations, respectively.

Result

A total of 63 optometrists participated in the study. Majority of them were females (69.8%, n = 44), Christians (65.1%), East Indians (47.6%), and 30 years and below (66.7%). Most (87%) of them utilized routine optometric equipment in their clinical practice including autorefractors, retinoscopes, direct ophthalmoscopes, lensometers, phoropters, slit lamp biomicroscopes, trial lens boxes, and visual acuity chart projectors. A few of them have noncontact tonometer (4.8%), Volk lenses (1.6%), and perform color vision tests (1.6%). Fewer (12.7%, n = 8) practitioners provided low-vision services. The use of pharmaceutical agents was prevalent among the participants (55.6%). Additionally, the provision of contact lenses was the most frequently practiced service among the participants (85.7%, n = 54). A significant association was observed between the provision of low-vision services and sex (p = 0.03).

Conclusion

The scope of optometry practice in Trinidad and Tobago is in accordance with the basic guidelines set out by the World Council of Optometry but there is need to get more involved in the provision of low vision and other specialty services.

Improving access to vision rehabilitation care: implementation of the South East Ontario Vision Rehabilitation Service

OBJECTIVE

To investigate the effect of the South East Ontario Vision Rehabilitation Service (SOVRS), a centrally administered, regionally delivered vision rehabilitation service, on access to vision rehabilitation care.

DESIGN

Pre-implementation (n = 1196) and post-implementation (n = 414) observational study.

PARTICIPANTS

Patients referred for low-vision assessment at the hospital-based Kingston Health Sciences Centre Vision Rehabilitation Clinic and community-based Southeastern Vision Loss Rehabilitation Ontario clinics from 2014 to 2019.

METHODS

Markers for access to care (e.g., patient rurality, diversity of referral source, distance and time travelled, and wait times) were compared before and after SOVRS implementation.

RESULTS

After SOVRS implementation, there was a significant increase (p < 0.001) in the number of rural patients seen in the community. After SOVRS implementation, the hospital-based Vision Rehabilitation Clinic site experienced a significant increase in referrals from outside of Kingston (p < 0.001) and non-eye-care clinicians (p < 0.001), a significant reduction in patient time and distance travelled (p < 0.001), a 6% decrease in median wait time for low-vision assessments, and a significant reduction in wait time between referral and first available appointment (p = 0.011).

CONCLUSION

SOVRS, a novel service-delivery model for vision rehabilitation care, improved the delivery of and access to vision rehabilitation care in southeast Ontario through the integration of regional resources and services.

Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade

OBJECTIVE

To determine the population-level predictors for being unscreened for diabetic retinopathy (DR) among individuals with diabetes in a developed country.

DESIGN

A retrospective population-based repeated-cross-sectional study.

PARTICIPANTS

All individuals with diabetes (types 1 and 2) aged ≥20 years in the universal health care system in Ontario were identified in the 2011-2013 and 2017-2019 time periods.

METHODS

The Mantel-Haenszel test was used for the relative risk (RR) comparison of subcategories stratified by the 2 cross-sectional time periods.

RESULTS

A total of 1 145 645 and 1 346 578 individuals with diabetes were identified in 2011-2013 and 2017-2019, respectively. The proportion of patients unscreened for DR declined very slightly from 35% (n = 405 967) in 2011-2013 to 34% (n = 455 027) in 2017-2019 of the population with diabetes (RR = 0.967; 95% CI, 0.964-0.9693; p < 0.0001). Young adults aged 20-39 years of age had the highest proportion of unscreened patients (62% and 58% in 2011-2013 and 2017-2019, respectively). Additionally, those who had a lower income quintile (RR = 1.039; 95% CI, 1.036-1.044; p < 0.0001), were recent immigrants (RR = 1.286; 95% CI, 1.280-1.293; p < 0.0001), lived in urban areas (RR = 1.149; 95% CI, 1.145-1.154; p < 0.0001), had a mental health history (RR = 1.117; 95% CI, 1.112-1.122; p < 0.0001), or lacked a connection to a primary care provider (RR = 1.656; 95% CI, 1.644-1.668; p < 0.0001) had a higher risk of being unscreened.

CONCLUSIONS

This population-based study suggests that over 1 decade, 33% of individuals with diabetes are unscreened for DR, and young age, low income, immigration, residing in a large city, mental health illness, and no primary care access are the main predictors.

Development of the WHO eye care competency framework

BACKGROUND

The eye care workforce, particularly in lower resource settings, face challenges of limited integration into the health system, limited workforce capacity, mismatch of workforce to population need and poor quality of care. In recognition of these challenges, coupled with a gap in existing tools, provides a strong rationale for the development of the Eye care competency framework (ECCF).

METHODS

A mixed methods approach was utilised to develop and validate the ECCF. Content was developed by extracting relevant components of existing frameworks used both within and outside of eye care. A diverse technical working group provided feedback and guidance on the structure, design, and content to create a preliminary draft. Competencies and activities were validated using a modified-Delphi study, and the framework was then piloted at four sites to understand how the tool can be implemented in different settings.

RESULTS

The final version of the ECCF included eight outcomes, nine guiding principles, and content of each of the key elements, including the six domains, 22 competencies, 21 activities, 193 behaviours and 234 tasks, and the knowledge and skills that underpin them. 95/112 participants from the six WHO regions completed the modified-Delphi study, yielding an average of 96% agreement across the competencies and activities in the ECCF. The pilot showcased the versatility and flexibility of the ECCF, where each of the four sites had a different experience in implementing the ECCF. All sites found that the ECCF enabled them to identify gaps within their current workforce documentation.

CONCLUSIONS

The ECCF was developed using a collaborative approach, reflecting the opinions of participants and stakeholders from all around the world. The comprehensive competencies and activities developed in the ECCF encompass the diverse roles of eye care workers, and thus encourage multi-disciplinary care and better integration into the health system. It is recommended that eye care workforce planners and developers use the ECCF, and adapt it to their context, to support workforce development and focus on the quality and scope of eye care service provision.

Progress on application of spatial epidemiology in ophthalmology

Most ocular diseases observed with cataract, chlamydia trachomatis, diabetic retinopathy, and uveitis, have their associations with environmental exposures, lifestyle, and habits, making their distribution has certain temporal and spatial features based essentially on epidemiology. Spatial epidemiology focuses on the use of geographic information systems (GIS), global navigation satellite systems (GNSS), and spatial analysis to map spatial distribution as well as change the tendency of diseases and investigate the health services status of populations. Recently, the spatial epidemic approach has been applied in the field of ophthalmology, which provides many valuable key messages on ocular disease prevention and control. This work briefly reviewed the context of spatial epidemiology and summarized its progress in the analysis of spatiotemporal distribution, non-monitoring area data estimation, influencing factors of ocular diseases, and allocation and utilization of eye health resources, to provide references for its application in the prevention and control of ocular diseases in the future.

Identifying vaccination deserts: The availability and distribution of pharmacists with authorization to administer injections in Ontario

Introduction:

Pharmacist-administered immunizations have been associated with improved vaccination rates; however, little is known about whether areas with little to no access to this service (“vaccination deserts”) exist. The objective of this work is to determine the geographic availability of pharmacists with authorization to administer injections in the province of Ontario.

Methods:

Ontario College of Pharmacists registry data were used to identify patient care–providing pharmacists in community pharmacies and their ability to administer injections. Their number of hours worked was converted into full-time equivalents (FTEs), assuming 40 hours per week represents 1 FTE. Practice site(s) were mapped by postal code and presented by Public Health Unit (PHU) area. Communities within PHUs were further categorized as urban or rural and northern or southern, with ratios of FTEs per 1000 population calculated for both injection-trained and non-injection-trained pharmacists.

Results:

In total, 74.6% of Ontario’s practising community pharmacists are authorized to provide injections. Northern PHUs had slightly better access to pharmacist injectors (0.61 FTEs/1000 overall vs 0.56/1000 in the south), while rural communities had lower availability (0.41 FTEs/1000) than urban communities (0.58 FTEs/1000). PHUs with greater population size and density had greater availability of pharmacist immunizers, while PHUs with greater land area were more likely to not have any immunizing pharmacists present ( p < 0.001 for all).

Discussion:

As pharmacists increasingly become preferred vaccination providers, awareness of disparities related to access to pharmacy-based immunizations and collaboration with public health and primary care providers to address them (e.g., through mobile vaccination clinics) will be required to ensure equitable access. Can Pharm J (Ott) 2022;155:xx-xx.