PRIMARY CARE
• Free and universal national health system.
• This care is offered throughout:
– primary, secondary, tertiary or specialized care.
• Complete network of outpatients´
departments and hospitals throughout the country.
• Acceptable healthcare system
– problems of overcrowding and waiting lists
41
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Prescription of drugs from the National Health Service (INSALUD) is practically free.
• Funded by company taxing and
compulsory percentage (6%) on the monthly earnings of employees.
42
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Private medical companies have made notable progress.
• Less crowded and more personalised system.
• Complement healthcare with a private insurance option.
43
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Optician-optometrist practices are defined by law as a healthcare
establishment.
• Must meet at least the following conditions:
44
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
– The permanent and ongoing presence of the Optician-Optometrist.
– Minimum set of instruments and protocols on proceedings.
– License, prior membership of the National College of Opticians-Optometrists of Spain.
– Inspection by the regional health authorities.
45
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• 63% of the Spanish population go to the optician-optometrist.
• 37% visit an ophthalmologist:
– 26% under the National Health Service – 11% attend private ophthalmologists or
those of private health insurance.
46
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
– Increased life expectancy – Improved quality of life
– Surgical and pharmacological advances
• Saturated national health ophthalmology services.
• Causes alarm and social dissatisfaction.
47
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• INSALUD has approached the National College of Opticians-Optometrists of
Spain.
• Optometrist’s help in reducing waiting lists
– Relieve ophthalmologist of everything to do with primary visual care
48
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Significant agreements for collaboration has been reached.
• In five autonomous Spanish regions:
– Community of Andalusia – Basque Country
– Community of Aragon
– Community of the Canary Islands – Community of Madrid
49
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Collaboration agreements have been set up:
– Regional health authority of the Andalusian Health Service
– Basque Health Service
– Department of Health, Consumption and Social Services of the Aragon General Deputation
– Canary Island Health Service
– Health Council of the Autonomous Community of Madrid
50
51
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Objectives:
– “To establish the mechanisms for the prevention of visual problems, the
correction and promotion of vision, aimed at patients, referred by the different health services of the various autonomous
regions, via family doctors or general practitioners”.
52
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
– The integration of the optician-optometrist as a primary sight carer in the national
health system.
– The publication of common protocols.
– To inform and advise the public of changes in visual capacity.
53
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Allows general practitioners, when
seeing a patient with visual problems
with no pathology, to refer this patient to an optometrist.
54
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Optometrists must meet several requirements.
• Must appear on an official list.
• Must carry out the following clinical procedures for all cases:
55
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
– Assessment of the refractive condition.
– Assessment of the afferent and efferent neurological pathways.
– Assessment of the individual’s flat fusion ability.
– To determine the integrity of the visual field of the macular region.
– To determine intraocular pressure value (IOP) – Refraction
– Binocularity – Ocular health
56
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Other tests to be carried out:
– Ophthalmoscopy – Tonometry
– Keratometry – Perimetry
– Confrontation visual fields – Slit lamp observation
– Retinography, etc.
57
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• If any pathological abnormality,
– the patient should be referred to the appropriate professional.
58
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Optician-optometrists should draw up an optometric report for the Health
Services’ epidemiological and statistical studies.
59
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• These agreements have entailed many political benefits for the National
College of Opticians-Optometrists.
• Great opportunity to form a part of the Spanish Public Health Service.
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THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• Benefits
– A universal service.
– Geographic dispersion.
– Agreement negotiated at corporate level.
– Strengthening of the profession.
– A challenge for the future.
– Experience in primary visual health care.
61
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• These agreements are the first step towards the total integration of the
Spanish optometrist into the National Health System in primary care.
62
THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN
PRIMARY CARE PRIMARY CARE
• If authorities wish to offer general public quality primary visual and ocular health care at less cost, they must consider
opticians-optometrists as independent suppliers of this primary care.
63
Summary Summary
• NATIONAL COLLEGE OF OPTICIANS-OPTOMETRISTS OF SPAIN
• OPTICIAN-OPTOMETRIST PROFESSION
• OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE
– Optics-Optometry in Spain: The role of the Optician-Optometrist
• THE SPANISH OPTOMETRIST IN PRIMARY CARE
• THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY
64
THE LATEST POLITICAL AND LEGISLATIVE THE LATEST POLITICAL AND LEGISLATIVE
ADVANCES IN SPANISH OPTOMETRY ADVANCES IN SPANISH OPTOMETRY
A. ROYAL DECREE ON HEALTH CARE ESTABLISHMENTS
B. LAW ON THE REGULATING OF HEALTHCARE PROFESSIONS
C. THE SUPREME COURT RULES AGAINST OPHTHALMOLOGISTS
D. THE ANDALUSIA HIGH COURT OF JUSTICE RULING
65
THE LATEST POLITICAL AND LEGISLATIVE THE LATEST POLITICAL AND LEGISLATIVE
ADVANCES IN SPANISH OPTOMETRY ADVANCES IN SPANISH OPTOMETRY
A. ROYAL DECREE ON HEALTH CARE ESTABLISHMENTS
B. LAW ON THE REGULATING OF HEALTHCARE PROFESSIONS
C. THE SUPREME COURT RULES AGAINST OPHTHALMOLOGISTS
D. THE ANDALUSIA HIGH COURT OF JUSTICE RULING
66