Abstract
Purpose :
Australian optometrists manage glaucoma in shared care agreements with ophthalmologists. Optometrists gained access to the Pharmaceutical Benefits Scheme (PBS) for glaucoma drugs in 2008. PBS data was explored to determine the extent of optometrists’ role in glaucoma management and compare prescribing patterns of optometrists and medical practitioners over time.
Methods :
PBS data were retrieved from 2009 to 2019 for topical glaucoma drugs. The number of scripts dispensed per year for each glaucoma drug and drug classes (α-agonists, β-blockers, carbonic anhydrase inhibitors (CAI), miotics, prostaglandins (PGA) and fixed combinations (FC)), and preservative free (PF) were determined. The proportion of optometrists’ scripts was calculated as a proxy measure for shared care uptake. Percent change over time, relative proportions of drug classes and most prescribed drug within each class were calculated for each professional group.
Results :
The number of glaucoma scripts dispensed per year (mean 3.70M, IQR 3.43 – 3.84M) has been stable since 2009 despite population ageing with the number of scripts prescribed per person (65y/>) ranging from 1.23 in 2009 to 0.86 in 2019. The proportion of optometrists’ scripts to total scripts has increased (0.04% in 2009 to 2.61% in 2019) but appears to be plateauing. Optometrists’ (OP) largest increases were for PGA (924 to 238,936) and FC (338 to 146,556). Medical practitioners’ (MP) scripts for miotics (-51.1%), β-blockers (-45.8%), PGA (-27.3%) have decreased, FC (55.8%) and CAI (17.5%) have increased, while α-agonists remained stable. PF use has increased since first introduced in 2013 accounting for 7.5% of scripts. Relative proportions of drug classes in 2019 were similar for both professions: PGA (OP 47%, MP 41%), FC (OP 35% , MP 39%), and others (OP 18.3%, MP 20.0%) The most frequently prescribed drugs in each class were the same for both professions.
Conclusions :
Optometrists prescribed a small but increasing proportion of glaucoma scripts indicating slow uptake of shared care agreements. Both professions exhibit similar prescribing patterns. The reduced number of scripts per person, decreased PGA and β-blockers, and increased FC prescribing by medical practitioners may reflect changes in glaucoma treatment paradigms. Opportunity exists for more optometrists to engage in glaucoma management via shared care agreements to assist with increased future demand.
This is a 2021 ARVO Annual Meeting abstract.