title: Optimal clinical management of eye problems: the role of optometrists in managed care plans.
abstract: BACKGROUND
  Recent developments in the education and licensure of optometrists have created new opportunities for more-efficient provision of eye care. This study was conducted to determine the extent to which optometrists provided various kinds of eye care independently in managed care organizations. We compared optometric practices in health plans located in states in which the legal authority of optometrists was limited, to optometric practices in plans situated in states in which optometric licensure permitted broader prescribing authority. The volume and nature of referrals to ophthalmologists were assessed in relation to state law and organizational protocols.
  
  
  METHODS
  A 15-item patient encounter form was developed and completed for all patients examined by the optometrists at each site during a 4-week period in 1998. Specific conditions were selected and criteria developed to help determine whether referrals to ophthalmologists were appropriate, or if they could have been managed by the optometrist These referrals were assessed by an independent panel of four optometrists.
  
  
  RESULTS
  This study documented that optometrists provide a substantial range of eye care, and their individual scope of practice is influenced not only by legal boundaries, but also by financial and organizational factors found within managed care organizations. The pattern of referrals to ophthalmologists helped indicate the extent to which optometrists were underutilized or used appropriately in various settings.
  
  
  CONCLUSIONS
  There is no single reliable predictor of whether optometrists will be used at the highest level of their abilities and scope of license. Although state licensure sets the overall parameters for care, optometric practice in managed care plans may be modified by internal protocols and organizational factors.
authors.affiliation: Center for Vision Care Policy, State College of Optometry, State University of New York, New York 10036, USA.
authors.forename: M
authors.initials: M
authors.lastname: Soroka
authors.forename: D M
authors.initials: DM
authors.lastname: Krumholz
authors.forename: M
authors.initials: M
authors.lastname: Krasner
authors.forename: J
authors.initials: J
authors.lastname: Portello
mesh_terms: D000368:Aged; D005128:Eye Diseases / Q000628:therapy*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D009885:Ophthalmology / Q000458:organization & administration; D009907:Optometry / Q000379:methods / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D014481:United States