PowerPoint adapted by BSK

1. THE NEW TPA/g CERTIFICATION PROCESSMark W. Harris, O.D.Dorothy L. Hitchmoth, O.D.David J. Caban, O.D. PowerPoint adapted by BSK

2. RSA 327 OPTOMETRY • CHANGES IN THE LAW THAT YOU MUST BE FAMILIAR WITH: • ANTI-VIRALS • GLAUCOMA TREATMENT • Primary Open-Angle Glaucoma (POAG)

3. ANTI-VIRALS • TOPICAL AND ORAL, AS APPROVED AND INCLUDED IN THE FORMULARY • OPHTHALMOLOGICAL CONSULT NO LONGER REQUIRED PRIOR TO Tx • REFERRAL IF NO IMPROVEMENT IN 10 DAYS

4. IT’S BETTER THAN IT WAS! • EVERYONE SHOULD BE INVOLVED UP TO HIS/HER COMFORT LEVEL • WE NEED TO DEMONSTRATE OUR COMPETENCE • NEW CHANGES MAKE IT EASIER TO REACH THE GOAL

5. THE TPA/g CERTIFICATION PROCESS HAS BEEN SIMPLIFIED! • Anyone willing to make the effort should be able to achieve independent treatment status. • Within a few years, most NH optometrists should be “tpa/g” certified. • No one will be forced to do it if they don’t want to.

6. GLAUCOMA CERTIFICATION • COURSE PLUS CO-MANAGEMENT STILL REQUIRED • FINE POINTS MUST BE WELL UNDERSTOOD • LAW ALLOWS FOR WAIVER OF BOTH COURSE AND CO-MANAGEMENT REQUIREMENTS • “GLAUCOMA” DEFINED AS POAG ONLY

7. FIRST STEP - GLAUCOMA PRESCRIPTIVE AUTHORITY • OD COMPLETES 40 HOUR COURSE, PASSES EXAM. • BOARD AUTOMATICALLY WAIVES COURSE FOR GRADS AFTER 2002 or ODs WITH 12 MOS FEDERAL GLAUCOMA TX CREDENTIALS. (RSA 327:6-C I (a), (b), (c)) • JPFCC MAY WAIVE COURSE FOR ODs WITH RESIDENCY or 12 MONTHS PRACTICE IN ANOTHER GLC STATE (RSA 327:6-C III (a), (b)) • OD NOW AUTHORIZED TO WRITE PRESCRIPTIONS FOR GLAUCOMA MEDS DURING CO-MANAGEMENT PERIOD COURSE NOT REQUIRED TO TREAT AACG ON EMERGENCY BASIS

8. THE CO-MANAGEMENT PROCESS PHASE 1 – CO-MANAGE 25 CASES (MINIMUM 20 NEW, 5 MAY BE PRE-EXISTING) FOR 18 MONTHS EACH CASE. • CASES YOU STARTED UNDER THE PREVIOUS LAW WILL COUNT AS NEW OR PRE-EXISTING DEPENDING ON THEIR ORIGINAL CLASSIFICATION. IF YOU QUALIFY YOU CAN OBTAIN A WAIVER OR REDUCTION IN THE NUMBER OF CO-MANAGED CASES • YOU MAY QUALIFY IF YOU FALL INTO ANY OF THE FOLLOWING CATEGORIES: • BOARD AUTOMATICALLY WAIVES ALL CASES FOR GRADS AFTER 2002 or ODs WITH 12 MOS FEDERAL GLAUCOMA TX CREDENTIALS. (RSA 327:6-C I (a), (b), (c)) • JPFCC MAY WAIVE OR REDUCE NUMBER OF REQUIRED CASES FOR ODs WITH RESIDENCY or 12 MONTHS PRACTICE IN ANOTHER GLAUCOMA STATE (RSA 327:6-C III (a), (b))

9. REQUESTING WAIVER • JPFCC WILL DETERMINE ELIGIBILITY FOR WAIVER BASED UPON DOCUMENTATION SUBMITTED • INCLUDE AS MUCH DOCUMENTATION AS YOU CAN WITH YOUR REQUEST! • CV • LETTERS OF RECOMMENDATION (LETTERS FROM OPHTHALMOLOGISTs CARRY A LOT OF WEIGHT) • CERTIFICATES OF COMPLETION (RESIDENCY CERTIFICATE, ETC.) • EVIDENCE OF GLAUCOMA CREDENTIALING COURSE IF YOU TOOK ONE • TMOD - DATE TAKEN AND SCORE ACHIEVED

10. TO WHOM DO I SEND A WAIVER REQUEST? Joint Pharmaceutical Formulary and Credentialing Committee David J. Caban, O.D., Secretary c/o Board of Registration in Optometry 2 Industrial Park Drive, Suite 8 Concord NH 03301

11. NO WAIVER, WHAT DO YOU DO? • YOU MUST PROVIDE EVIDENCE OF SUCCESSFUL COLLABORATIVE TREATMENT AND CO-MANAGEMENT OF 25 GLAUCOMA PATIENTS • UP TO 5 MAY BE ESTABLISHED GLAUCOMA PATIENTS • A “NEW GLAUCOMA PATIENT” MEANS A PATIENT WHOM YOU ARE THE FIRST TO DIAGNOSE WITH POAG, OR • WHO HAS BEEN PREVIOUSLY DIAGNOSED WITH POAG BUT IS NEW TO YOUR PRACTICE • EACH PATIENT MUST BE FOLLOWED FOR A PERIOD OF NOT LESS THAN 18 MONTHS • EXCEED THE MINIMUM NUMBER OF PATIENTS - IN CASE YOU HAVE DROP OUTS • ESTABLISH PROTOCOLS WITH YOUR CO-MANAGING OPHTHALMOLOGISTs • OD SHOULD WRITE THE Rx • SAMPLES USED AS APPROPRIATE

12. REFERRAL CRITERIA • DURING INITIAL CO-MANAGEMENT, THE OD SHALL CONSULT WITH THE OPHTHALMOLOGIST WHEN ANY OF THE FOLLOWING OCCURS: • TARGET PRESSURE NOT ACHIEVED WITHIN 90 DAYS • DOCUMENTED PROGRESSION OF OPTIC NERVE HEAD DAMAGE • DOCUMENTED, REPEATED PROGRESSION OF VISUAL FIELD LOSS • PATIENT DEVELOPS ANGLE CLOSURE OR OTHER SECONDARY GLC (e.g. pigmentary or pseudoexfoliative glc)

13. ONCE I AM TPA/G CERTIFED AM I DONE? • UNFORTUNATELY, NO • UPON CERTIFICATION TO TREAT GLAUCOMA (Phase II), FOR A PERIOD OF 24 MONTHS, OPTOMETRISTS SHALL CONSULT WITH AN OPHTHALMOLOGIST WITHIN 30 DAYS FOR CONFIRMATION OF DIAGNOSIS AND REVIEW OF TREATMENT PLAN

14. IS THAT IT? • YOU WILL ALWAYS BE REQUIRED TO CONSULT WITH AN OPHTHALMOLOGIST IF THERE IS • DOCUMENTED PROGRESSION OF ONH DAMAGE, OR • DOCUMENTED, REPEATABLE PROGRESSION OF VF LOSS, UNDER MAXIMUM MEDICAL THERAPY, • or THE PATIENT DEVELOPS SECONDARY OR ANGLE CLOSURE GLAUCOMA • THIS REQUIREMENT CONTINUES INDEFINITELY • THIS IS WHAT WE WOULD DO ANYWAY!

15. QUESTIONS OR COMMENTS?