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A decade after getting TPA legislation, Montana ODs prescribe, comanage effectively
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BILLINGS, Mont. — A decade has elapsed since Montana optometrists obtained therapeutic pharmaceutical agent (TPA) legislation, and in that time they have increased their therapeutic abilities and have worked to enhance relationships with ophthalmology. According to Brian Linde, OD, in private practice here, both efforts have been successful.
"Most ophthalmologists in our state currently comanage cataract and glaucoma patients, so many optometrists already enjoy that professional relationship," said Dr. Linde, who is president of the Montana Optometric Association. "Partially because we’re a rural state, patients are traveling hundreds of miles to receive ophthalmologic care, and sometimes comanagement is based simply on necessity."
This relationship has gone a step further, he said, to include several committees of optometrists and ophthalmologists working together to improve patient care. For example, Dr. Linde said, both groups have worked together to develop a school screening program for children, and a preferred provider organization recently formed is made up of equal representation by ODs and MDs.
Dr. Linde said the state’s 157 licensed ODs are well organized and active legislatively. "We haven’t gone back to the legislature for 4 years to seek any enhancements, but we have been watching for discrimination language and HMO legislation and making sure we have access to these issues," he said.
DEA no problem here
Montana amplified its TPA legislation only once in the past 10 years — in 1993 to allow ODs to prescribe topical steroids. Optometrists here can also prescribe all topical anti-infectives, antibiotics, antivirals, antifungals and oral analgesics. They can also perform foreign body removal.
They cannot, at this time, prescribe oral antibiotics, treat glaucoma or use injectables or lasers. Because they can legally prescribe some narcotics in Schedule II through Schedule V under the Controlled Substances Act of 1970, Montana ODs can obtain a mid-level practitioner Drug Enforcement Administration (DEA) license.
"I have had my DEA license for 9 years, and it hasn’t been an issue or problem here," Dr. Linde said.
Nearly 80% of the state’s ODs are TPA certified, Dr. Linde said, and he feels confident that every optometrist who can prescribe does so to the full extent of the law. "Because Montana is a rural state, it requires doctors who are TPA certified and hundreds of miles away from an ophthalmologic second opinion to institute care and provide follow-up. It’s good for patient care."
In 1987, after Montana ODs received TPA legislation, optometrists were required to pass a 120-hour certification course. Following the 1993 amplification, ODs had to complete a certification course that was organized through optometry and ophthalmology together.
In his role as education and convention chairman of the state association for the past 5 years, Dr. Linde has tried to ensure that Montana’s ODs are comfortable prescribing therapeutics. "Our education program is geared to ensure that our ODs get the background they need to deal with patients and to use TPAs," he said.
Educating legislators
Dr. Lindesaid the state association may look at broadening Montana’s TPA law in the future, but for the time being is concentrating on cooperative efforts already established with ophthalmology throughout the state. "We haven’t expanded our scope in 4 years, and it would be another 2 years before we would have any expanded therapeutics at our disposal," he said. "It is something we’re looking at."
What the state’s ODs have been able to do, however, is educate legislators about optometry’s role as primary eye care providers.
"We don’t have large numbers of doctors to lobby legislators, and most of the legislators are spread across rural areas, but we do see them as patients," Dr. Linde said. "So it becomes a little easier when they see firsthand that the level and quality of care is changing, and they begin to appreciate optometry’s changing scope of practice."
For Your Information:
- Brian Linde, OD, may be contacted at 430 Lake Elmo, Suite 1, Billings, MT 59105; (406) 252-9927; fax: (406) 252-6567. The Montana Optometric Association may be contacted at 36 South Last Chance Gulch, Suite A, Helena, MT 59601; (406) 443-1160; fax: (406) 443-4614.