Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Aston University, Birmingham, UK.
Eye (Lond). 2020 Dec;34(12):2284-2294. doi: 10.1038/s41433-020-0839-7. Epub 2020 Mar 17.
The specialty-registration of independent prescribing (IP) was introduced for optometrists in 2008, which extended their roles including into acute ophthalmic services (AOS). The present study is the first since IP's introduction to test concordance between IP optometrists and consultant ophthalmologists for diagnosis and management in AOS.
The study ran prospectively for 2 years at Manchester Royal Eye Hospital (MREH). Each participant was individually assessed by an IP optometrist and then by the reference standard of a consultant ophthalmologist; diagnosis and management were recorded on separate, masked proformas. IP optometrists were compared to the reference standard in stages. Cases of disagreement were arbitrated by an independent consultant ophthalmologist. Cases where disagreement persisted after arbitration underwent consensus-review. Agreement was measured with percentages, and where possible kappa (Κ), for: diagnosis, prescribing decision, immediate management (interventions during assessment) and onward management (review, refer or discharge).
A total of 321 participants presented with 423 diagnoses. Agreement between all IP optometrists and the staged reference standard was as follows: 'almost perfect' for diagnosis (Κ = 0.882 ± 0.018), 'substantial' for prescribing decision (Κ = 0.745 ± 0.034) and 'almost perfect' for onward management (0.822 ± 0.032). Percentage-agreement between all IP optometrists and the staged reference standard per diagnosis was 82.0% (CI 78.1-85.4%), and per participant using stepwise weighting was 85.7% (CI 81.4-89.1%).
Clinical decision-making in MREH's AOS by experienced and appropriately trained IP optometrists is concordant with consultant ophthalmologists. This is the first study to explore and validate IP optometrists' role in the high-risk field of AOS.
独立处方（IP）的专业注册于 2008 年引入视光师，扩大了他们的角色，包括急性眼科服务（AOS）。本研究是 IP 引入以来首次测试 AOS 中 IP 视光师与顾问眼科医生在诊断和管理方面的一致性。
该研究在曼彻斯特皇家眼科医院（MREH）前瞻性进行了 2 年。每位参与者均由 IP 视光师进行单独评估，然后由顾问眼科医生进行参考标准评估；诊断和管理均记录在单独的、掩蔽的预印本上。IP 视光师在不同阶段与参考标准进行比较。有分歧的病例由独立顾问眼科医生仲裁。仲裁后仍存在分歧的病例进行共识审查。通过百分比和可能的kappa（Κ）来衡量一致性：诊断、处方决策、即时管理（评估期间的干预）和后续管理（审查、转诊或出院）。
共有 321 名参与者出现 423 种诊断。所有 IP 视光师与分阶段参考标准之间的一致性如下：诊断为“几乎完美”（Κ = 0.882 ± 0.018），处方决策为“实质性”（Κ = 0.745 ± 0.034），后续管理为“几乎完美”（0.822 ± 0.032）。所有 IP 视光师与分阶段参考标准的诊断百分比一致性为 82.0%（CI 78.1-85.4%），每个参与者使用逐步加权的一致性为 85.7%（CI 81.4-89.1%）。
经验丰富且经过适当培训的 IP 视光师在 MREH 的 AOS 中的临床决策与顾问眼科医生一致。这是第一项探索和验证 IP 视光师在 AOS 高风险领域角色的研究。
