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New Hampshire ODs enjoy high TPA certification rate, utilization
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PORTSMOUTH, N.H. - Optometrists in this small New England state get high marks for their therapeutic pharmaceutical agent (TPA) certification rate, and this year they plan to take a closer look at hospital privileges.
"We are in the stages of finding out what the issues are with respect to hospital privileges, and the state association has formed a Hospital Privileges Committee," said Brian S. Klinger, OD, a solo practitioner for 31 years and executive director of the state optometric association.
The American Optometric Association recommends that optometrists who are qualified apply for hospital privileges, and ODs in New Hampshire "hope to follow that lead," said Dr. Klinger.
New Hampshire's TPA law went into effect Jan. 1, 1993, and allows the 155 licensed ODs in the state to prescribe topical and oral agents to treat allergies and infections as well as oral agents for pain, including controlled substances.
According to Dr. Klinger, obtaining a Drug Enforcement Administration (DEA) mid-provider level license to prescribe controlled substances has not been an issue in New Hampshire. "As soon as the DEA sees in your law that you are allowed to prescribe controlled substances, there's no problem," he said.
High certification rates
Most of New Hampshire's optometrists are already taking full advantage of their current prescribing laws - nearly 90% are TPA-certified.
To become certified, New Hampshire ODs who graduated from optometry school before TPA went into effect had to attend a 105-hour course in pharmaceuticals, which includes 25 hours of clinical experience, and pass the Treatment and Management of Ocular Disease exam. There is no required supervision with an ophthalmologist. Optometrists who graduated after Jan. 1, 1993, have already passed the National Board Exams in order to receive TPA certification.
"Most of us got certified when our law went into effect," Dr. Klinger said. "All of us, especially those who have been in practice for a while, have a good sense of what we're comfortable prescribing and what we're not. And while I'm delighted to have the privileges and I use them, that doesn't mean I am afraid to refer something I am concerned about."
Using TPA privileges appropriately, Dr. Klinger said, "is to treat something if I feel comfortable treating it and it's within the law." Referrals may also be necessary due to TPA limitations. New Hampshire ODs cannot prescribe antivirals or steroids at this time, and if Dr. Klinger feels a patient has a condition that requires either agent, he must refer.
He added, "Also, if I'm treating a condition and it's not responding the way I expect, I don't have any qualms about referring for a second opinion. That's just good patient care."
For Your Information:
- Brian S. Klinger, OD, may be contacted at 195 Hanover St., Portsmouth, NH 03801; (603) 431-6814; fax: (603) 433-8815. Dr. Klinger has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any company mentioned.