Yap Tiong Peng, Mishu Masuma Pervin
IGARD Paediatric Optometry and Vision Therapy Centre, Singapore 229469, Singapore.
Institute of Epidemiology and Healthcare, Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK.
Children (Basel). 2024 Dec 20;11(12):1548. doi: 10.3390/children11121548.
Singapore's national myopia prevention efforts have largely focused on school vision screening and public education on outdoor activities in the past two decades. Given the emergence of evidence-based myopia interventions, this policy review and analysis investigates the potential benefits and drawbacks of optometrist prescribing privileges as it has been proposed to reduce the barriers to access effective interventions, such as combined therapy (e.g., orthokeratology treatment and low-dose atropine therapy). In this policy analysis, two policy options were identified to be feasible based on evidence from a systematic literature search and they were analysed along with status quo using the Centers for Disease Control and Prevention (CDC) Policy Analysis Framework. This includes independent prescribing and supplementary prescribing, where the former entails autonomous clinical decision making, and the latter entails co-management with ophthalmological supervision. The policy review and analysis found independent prescribing the most favourable and concluded that this should be implemented in view of its benefits for the community. Public health impact is expected to be substantial due to increased patient access, reduced treatment costs, early interventions, improved treatment compliance, and reduced wait times and inconvenience. It is feasible because treatment processes can be streamlined, and it can be implemented based on existing collaborative prescribing frameworks. Economical and budgetary impact is also substantial given the direct savings generated, which can consequently help to reduce the disease burden.
在过去二十年里，新加坡全国性的近视预防工作主要集中在学校视力筛查和关于户外活动的公众教育上。鉴于循证近视干预措施的出现，本次政策审查与分析探讨了验光师处方权的潜在利弊，因为有人提议赋予验光师处方权以减少获取有效干预措施（如联合治疗，例如角膜塑形术治疗和低剂量阿托品治疗）的障碍。在本次政策分析中，基于系统文献检索的证据确定了两种可行的政策选项，并使用美国疾病控制与预防中心（CDC）的政策分析框架将其与现状一起进行了分析。这包括独立处方和补充处方，前者需要自主临床决策，后者需要在眼科监督下进行共同管理。政策审查与分析发现独立处方最为有利，并得出结论，鉴于其对社区的益处，应予以实施。预计公共卫生影响将十分显著，原因在于患者就诊机会增加、治疗成本降低、早期干预、治疗依从性提高以及等待时间和不便减少。这是可行的，因为可以简化治疗流程，并且可以基于现有的联合处方框架来实施。鉴于直接产生的节省费用，经济和预算影响也很显著，这进而有助于减轻疾病负担。
