Regional Disparities in Therapeutic Prescribing Trends of New Zealand Optometrists

Abstract

The purpose of the thesis was to investigate the therapeutic prescribing trends of New Zealand (NZ) optometrists. The specific aims were: A) to investigate the distribution of optometrists across the District Health Board (DHB) regions, B) to analyse the 10-year therapeutic pharmaceutical agent (TPA) data of optometrists, C) to examine the contribution that optometrists were making to the prescribing of TPAs by all health practitioners, and D) to investigate the practice and prescribing behaviour of optometrists using a survey. Methods: A: An optometrists' database was created using the Optometrists and Dispensing Opticians Board register. The distribution of practitioners across the District Health Board (DHB) regions of NZ was analysed. B: All TPAs prescribed by optometrists during the 10-year period (2008-2017) were analysed using data obtained from the Ministry of Health. C: The number of ocular TPAs prescribed by all health practitioners during the 5-year period (2012-2016) was extracted from the government pharmaceutical database for all health practitioners and analysed with the TPA data for optometrists. D: A survey was developed using Qualtrics software and distributed to optometrists at conferences and using optometry organisations' distribution channels. Results: A: Optometrists were concentrated in central Auckland and other highly populated DHB regions. B: The number of TPAs prescribed during the 10-year period increased by almost 20-fold. Optometrists most commonly prescribed anti-allergy, anti-infective, and anti-inflammatory TPAs, while glaucoma TPAs represented a smaller proportion of the total TPAs prescribed. C: Optometrists contributed to 3-5% of anti-allergy and anti-inflammatory TPAs prescribed by all health practitioners. D: Ninety-nine responses were analysed. Glaucoma and oral TPAs, and smoking cessation were topics about which optometrists could benefit from continuing professional development programmes. Conclusions: Factors affecting TPA-optometrists' therapeutic prescribing trends in the regions were: the population size of the DHB region, population-to-optometrist ratios, the number of optometrists who were prescribing large numbers of TPAs per year, and the number of Board approved glaucoma prescribers. Canterbury and many of the smaller DHB regions were not prescribing the expected number of TPAs, based on regional populations. Further investigation is required to evaluate how to efficiently deliver eye care to all New Zealanders.