Use of clinical practice guidelines by executive directors of optometric associations

The process of developing the American Optometric Association's (AOA) Optometric Clinical Practice Guidelines began in 1989 under the direction of John F. Amos, O.D., M.S., then chair of the AOA's Clinical Care Center. The guideline development process used by the AOA was modeled after the recommendations established by the Agency for Health Care Policy and Research in response to the federal government encouraging health care groups to develop clinical guidelines to enhance the quality, appropriateness, and effectiveness of health care. The guideline topics were chosen for their importance in the education of members, health care payers, and state legislators. A principal author and a consensus panel of experts then were chosen for each subject area. This group was responsible for transforming the latest scientific research and expert judgment into a document that would apply to everyday optometric practice. Thirteen guidelines were developed and mailed to AOA members in 1994 and 1995. Additional guidelines were mailed as they were approved. Currently, there are 20 guidelines available.

A survey was mailed to the executive director of the optometric association of each state and the District of Columbia and to the chief of optometry of each of the federal services. Telephone follow-up was made to nonrespondents, and an additional copy of the survey was mailed to them with telephone follow-up again taking place for those who did not respond.

Forty-three of the surveys were returned for a response rate of 78%. Seventy-six percent of the respondents stated that they had received the guidelines. The sections that were found most useful to the respondents were those related to Description and Classification, Basis of Treatment, and Treatment Options. The guidelines were most often used by these groups to improve the quality of eye care, expand optometric involvement in health programs, affect public policy, and overcome problems with insurance groups.

Optometric organizations have found the clinical practice guidelines useful beyond their primary goal of enhancing the quality of patient care. They have been used effectively to help educate other parties about optometry and its role as a primary health care profession.