Prescription writing: Exercise the right ODs fought so hard to win

Issue: January 1997

ByLouis J. Catania, OD, FAAO

Operation Optometry Prescribe The profession of optometry has just about arrived in the mainstream of therapeutic eye care. I say "just about" not because there remains only one state to complete its therapeutic legislative efforts, nor because amplifications of many state laws still must be completed. My "just about" comment relates more to a portion of therapeutic care that many optometrists in authorized therapeutic states continue to have a reluctance to implement or choose to relinquish their right to perform. I speak of prescription writing.

Part and parcel of therapeutic patient care by any health professional is the writing of a prescription for a therapeutic agent deemed necessary for patient care. Substituting this process by dispensing the drug directly or providing a sample to the patient — other than for extenuating circumstances — is an error in professional practice and judgment.

Sample only in an emergency

Louis J. Catania, OD [photo] --- Louis J. Catania, OD

The error of dispensing directly or sampling drugs to patients has many negative considerations. A 1987 editorial in the New England Journal of Medicine recommended that physicians avoid sampling or dispensing medicines directly to patients except in emergency situations or extenuating circumstances involving inaccessibility or assistance to an indigent patient. Such advice should also apply to practicing optometrists for the following reasons:

Clinical reasons for prescribing

Patient compliance is improved. The patient perceives more value in the care and need for the drug when it is prescribed. If a free sample runs out, the patient will tend not to continue care even if indicated.
In chronic conditions, prescribing a drug allows the doctor to establish a therapeutic regimen to which the patient will more likely adhere.
Expanding insurance coverage for prescriptions is relieving the issue of cost to the patient.

Legal reasons

A practitioner is under the same legal responsibility (for example, accurate diagnosis, correct therapy, minimum standard of care) whether a prescription is written, dispensed directly or provided as a sample to a patient.
In most courts of law, if a practitioner dispenses a drug to a patient or provides a sample, he or she can be held to all of the provisions detailed in the pharmacy act of the state, including such things as labeling requirements and advising the patient of risks.

Professional reasons

Community pharmacists can be the optometrists' best friend by providing support services and patient referrals, a professional resource regarding drug information and an overall ally to your practice.
If community pharmacists receive little or no prescriptions from your office, they may never know that you or your practice even exist, or they might otherwise consider you a dispensing competitor. Either perception would destroy any hope of a potentially valuable alliance.
Pharmaceutical companies closely track prescriptions for each of their proprietary products filled by pharmacies. Lack of optometric prescription writing reduces the company's appreciation and anticipation of optometrists' potential as prescribing health professionals.
Such an attitude produces: a lack of incentive to provide practicing optometrists with educational materials, samples or information on new drugs; a reduced interest in supporting optometric continuing education; and a disinterest in advertising in optometric journals and supporting our research and literature.
A lack of documented optometric prescriptions from company statistics and regulatory agency studies has created a perception of minimal optometric primary therapeutic eye care. This is used against optometry by our adversaries in legislative efforts nationwide.

In his book, The Transformation of American Medicine (New York: Basic Books, 1982), Paul Starr describes how the profession of pharmacy suffered an insidious loss of its recognition, economic growth and prestige as a health care profession when, through negotiations with medicine in the last century, it relinquished its rights to writing prescriptions.

During the past 20 years most optometrists have gained this right through education and legislation. Notwithstanding its long, hard struggle to attain such rights, in 1996 the profession of optometry delivered more than 50% of America's eye care, while its percentage of ophthalmic drug prescription writing (2.5%) lagged woefully behind ophthalmology (42.1%), pediatrics (11.9%), family practice (9.6%), internal medicine (5.1%) and osteopathy (3.8%).

All optometrists know how hard we have fought over the past 20 years to provide better care for our patients through the right to use therapeutic pharmaceutical agents in our practices. Now we all must understand the importance of exercising this right each time we treat a patient with a therapeutic agent. Indeed, prescription writing will help us enter the mainstream of prescribing health professionals in the eyes of our patients, our fellow health professionals — especially pharmacists — and the pharmaceutical companies whom we want and need to support our practices and our profession.

For Your Information:
Louis J. Catania, OD, is a charter member of the Primary Care Optometry News Editorial Advisory Board. He is also optometric director of Global Vision Inc., 4655 Salisbury Rd., Ste. 110, Jacksonville, FL 32256; (904) 281-1800.