Use of diagnostic techniques by private practising optometrists in South Africa

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Fraser, Johanna Antoinette
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University of the Free State
Introduction: In South Africa, the optometric profession has seen two expansions of the scope of practice within the last two decades. The first of the two allowed optometrists to make use of techniques that required the use of diagnostic pharmaceutical agents. Aim: The purpose of the study was to establish the extent to which the four specific diagnostic techniques are utilised and if there exist barriers to their utilisation. Methods: A cross-sectional study was conducted to ascertain the utilisation of diagnostic techniques. The data was collected through a self-administered online questionnaire. The questionnaire contained questions on demographics, practice trends, utilisation of diagnostic techniques, as well as the registration status of the optometrists. Results: A total of 141 responses were received, and 118 were included for data analysis. There were 46 (39.0%) male participants and 72 (61.0%) were female. Ninety-eight (83.1%) of the participants had a diagnostic qualification, of which 49 (50.0%) were correctly registered with the HPCSA for diagnostic practice. Only 13.4% participants indicated that they performed contact tonometry at every visit, while slit-lamp fundus examinations was performed at every visit by 18.6% of the participants. BIO was only performed on indication by 20.8% of participants and gonioscopy was similarly only performed on indication by 34.7% of participants. Diagnostic techniques and procedures were mostly underutilised as many did not perform applanation tonometry (67.0%), binocular indirect ophthalmoscopy (79.2%), slit-lamp fundus examination (41.2%) and gonioscopy (64.3%). While optometrists were more confident in performing applanation tonometry (52.0%) and slit-lamp fundus examination (64.3%), confidence was considered a barrier for binocular indirect ophthalmoscopy (62.3%) and gonioscopy (54.1%). The lack of reimbursement was regarded as a significant barrier for 63.3% of participants, and 82.5% of respondents indicated the cost of acquiring the specific equipment was prohibitive. Most participants (92.8%) agreed that diagnostic privileges were appropriate for optometrists as well as the therapeutic scope of practice expansion (96.9%). Of those participants who were not correctly registered for diagnostic practice with the HPCSA, the majority (69.4%) were aware of the process to amend their registration status. The administrative process being too cumbersome and time-consuming was the most commonly stated barrier to amending the registration status of participants who were incorrectly registered. Conclusion: The study indicates that diagnostic techniques are mostly underutilised and optometrists prefer non-invasive alternative techniques over methods that are considered to be the gold standard. Another finding of the study is that there exists a discrepancy between the number of optometrists who are registered for diagnostic practice and the number of optometrists who have acquired a diagnostic qualification. It is recommended that an audit be done on the registration status of optometrists as to ascertain the correctness of the register and to have it amended if needed. It is further recommended that further studies should be done to ascertain the compliance of optometrists concerning their registrations and scope of practice. The reimbursement models need to be revisited, as well as the training of optometrists to ensure appropriate levels of confidence in diagnostic techniques amongst practitioners. These models should be geared towards professional services, emphasising the diagnosis and management of ocular diseases to motivate optometrists to practice more extensively within their full scope of practice.
Dissertation (M. Optometry (Optometry))--University of the Free State, 2020, Optometrists - South Africa, Optometry - Practice - South Africa, Diagnostic techniques - South Africa