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Rhode Island ODs are earning glaucoma certification
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CRANSTON, R.I. - Optometrists here have learned, since passing therapeutic pharmaceutical agent (TPA) legislation 13 years ago, that simply having a TPA law does not guarantee full scope of practice. "You can have all the prescribing privileges you want but if you can't use them or get reimbursed for them, that ultimately defeats the purpose," said Louise DiChiara-Pastore, OD, RPh, who just completed a 1-year term as state association president.
Rhode Island is home to approximately 130 practicing ODs and was the seventh state in the country to adopt TPA legislation for optometry. Amplification, however, did not happen in Rhode Island until 1997. Now, ODs here can prescribe all topical agents, including antivirals, glaucoma medications and steroids. They cannot prescribe oral agents or controlled substances.
Dr. DiChiara-Pastore said several insurers in the state have created "dummy" Drug Enforcement Administration numbers for their system so optometrists at this time have no trouble writing in-state prescriptions.
"Another thing we've done in this state is to create legislation that allows optometrists to practice to the full extent of their therapeutic privileges, so they can be reimbursed for any and all treatment that falls under the practice law," Dr. DiChiara-Pastore said. This statute, adopted in the past 5 years, has helped Rhode Island complete the prescribing picture, she said.
Phasing in glaucoma
The ability to treat glaucoma is a year old legislatively, but still may be another year away from happening clinically, Dr. DiChiara-Pastore said. "That privilege is being phased in," she said. Part of this certification involves 1 year, at minimum, of clinical case management under the supervision of an ophthalmologist.
"You must manage a certain number of newly diagnosed glaucoma cases for 1 year or until they are stable," she said.
Dr. DiChiara-Pastore will not complete her clinical management portion in 1 year and believes it will take most optometrists 2 to 3 years to finish this part as well as the paperwork associated with glaucoma certification.
MD-OD relationships
The relationship between optometrists and ophthalmologists has, for the most part, improved since TPA legislation was passed, Dr. DiChiara-Pastore said. "Ophthalmologists get more specific referrals because of TPA privileges and what optometrists can treat," she said.
Rhode Island does not have legislation that specifically addresses hospital privileges for ODs, Dr. DiChiara-Pas- tore said, because each institution is left to make its own determination. This seems to be working at the present time, she said, and just recently three ODs were granted privileges at a hospital in the southern part of the state.
Dr. DiChiara-Pastore is in her 10th year of practice with her father, Frank W. DiChiara, OD, in a general optometric practice. Their practice is in a medical building with a walk-in emergency room, which means both doctors see more than a few emergency referrals.
"Steroids and antibiotics are the most common prescriptions we write here," Dr. DiChiara-Pastore said.
She estimates that she writes as few as five or as many as 20 prescriptions in a week, not counting the prescriptions her father writes. "A lot of that comes from the emergency room; but in the regular practice, we also treat a variety of medical problems," she said.
For Your Information:
- Louise DiChiara-Pastore, OD, RPh, may be contacted at 1150 Reservoir Ave., Suite LL5, Cranston, RI 02920; (401) 943-8151; fax: (401) 943-1324. She has no direct financial interest in the products mentioned in this article, nor is she a paid consultant for any companies mentioned.